Presentation on theme: "Genitourinary Trauma Dr. Andrew McDonald Sept. 19, 2006"— Presentation transcript:
1Genitourinary Trauma Dr. Andrew McDonald Sept. 19, 2006 Group B rounds presentation
2Goals Interactive discussion of GU trauma cases Review relevant anatomy and epidemiology as neededReview current diagnostic and management approaches
3Learning 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?
4Case 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?
5Case 1 Epidemiology ~4% of trauma centre pts have GU injury 80% renal, 10% bladder, 10% other72% minor, 17%moderate, 11% major90+% conservative management
6Case 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
7Case 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
8Case 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
10Case 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
31Case 3 30 year old woman stabbed to flank and lower abdomen Hemodynamically stableCatheterized for clear urineDoes she likely have a GU injury?
32Case 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
33Case 3 Needs renal/ureter test e.g. CT/IVP Needs cystogram Low threshold for Urology referral
34Other 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
35Pediatric traumaLow threshold for CT in blunt abd trauma due to difficult examDon’t work up microscopic hematuria alone if reliable
36Mgt Summary Urology consultation for Ongoing renal hemorrhage Major renal laceration/vascular inj on CTPenetrating renal/ureteral traumaIntraperitoneal bladder ruptureUrethral injuryPenile reconstruction/fractureTesticular rupture
37Learning 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?