Presentation on theme: "Genitourinary Trauma Dr. Andrew McDonald Sept. 19, 2006"— Presentation transcript:
1 Genitourinary Trauma Dr. Andrew McDonald Sept. 19, 2006 Group B rounds presentation
2 Goals Interactive discussion of GU trauma cases Review relevant anatomy and epidemiology as neededReview current diagnostic and management approaches
3 Learning objectives When to suspect GU injury? Significance of hematuria or pelvic #?When to withhold a Foley catheter?When to do a cystogram/CT cystogram?Is CT grading of renal injuries helpful?What are the management strategies and when to call Urology?How do we approach penetrating GU trauma?
4 Case 1 21 year old man ejected from a car at high speed Hypotension at scene improves with fluidsHas mild abdominal tenderness with left flank abrasionsDoes he likely have a GU injury?
5 Case 1 Epidemiology ~4% of trauma centre pts have GU injury 80% renal, 10% bladder, 10% other72% minor, 17%moderate, 11% major90+% conservative management
6 Case 1 Index of Suspicion Hx – deceleration injuries, abd blunt trauma, “straddle” injuryPx – flank tenderness/bruising/abrasion, lower rib injury, abd tenderness, perineal hematoma, meatal blood, abn rectal exam
7 Case 1 Basic Investigations Pelvic xray~90% bladder rupture have a pelvic fracture10% of pelvic fracture have bladder injuryAnterior pelvic fracture think of post urethral injury
8 Case 1 Basic Investigations UrinalysisMee, S. J. Urology 141:All significant renal injuries had gross hematuria OR microhematuria and hypotensionDegree of hematuria not correlated to injuryBlunt trauma with shock usually get CT abdWe have stopped dipping urines
9 Case 1 Pelvis xray Catheter urine Further investigate? Stable pelvic fractureCatheter urineGross hematuriaFurther investigate?
10 Case 1 Renal Grading on CT I -contusion/subcapsular hematomaII -small cortical laceration/non- expanding retroperitoneal hematomaIII -laceration >1cm or extravasationIV -laceration down to collecting system or vascular injuryV -shattered kidney/avulsed hilum
30 Case 2 Management Surgical repair Intraperitoneal bladder rupture Some Urethral repairs
31 Case 3 30 year old woman stabbed to flank and lower abdomen Hemodynamically stableCatheterized for clear urineDoes she likely have a GU injury?
32 Case 3 Need to also consider ureter injury Hematuria correlates poorly in penetrating GU injuryHigher proportion go to operative repairDecision to work up based on anatomy and index of suspicion
33 Case 3 Needs renal/ureter test e.g. CT/IVP Needs cystogram Low threshold for Urology referral
34 Other injuries Penis Scrotum/testes Penetrating, skin avulsion and amputation repaired surgically“fracture” repaired and drained surgicallyScrotum/testesHematocele and contusion (mild) or rupture (severe, needs exploration)Penetrating injuries need exploration
35 Pediatric traumaLow threshold for CT in blunt abd trauma due to difficult examDon’t work up microscopic hematuria alone if reliable
36 Mgt Summary Urology consultation for Ongoing renal hemorrhage Major renal laceration/vascular inj on CTPenetrating renal/ureteral traumaIntraperitoneal bladder ruptureUrethral injuryPenile reconstruction/fractureTesticular rupture
37 Learning objectives When to suspect GU injury? Significance of hematuria or pelvic #?When to withhold a Foley catheter?When to do a cystogram/CT cystogram?Is CT grading of renal injuries helpful?What are the management strategies and when to call Urology?How do we approach penetrating GU trauma?