Genitourinary Trauma

Aka: Genitourinary Trauma, Bladder Trauma, Urethral Trauma, Ureteral Trauma, Penile Trauma, Scrotal Trauma, Vaginal Trauma, Vulvar Trauma

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II. Exam

  1. Pelvic stability
  2. Perineum exam
  3. Vaginal and pelvic exam in women
  4. Scrotal exam in men
  5. Evaluate for bood at Urethral meatus

III. Associated Conditions: Urinary Tract

  1. See Pelvic Fracture
  2. See Renal Laceration
  3. Bladder rupture
    1. Intraperitoneal Bladder rupture (Bladder dome injury)
      1. Emergent surgery
    2. Extraperitoneal Bladder rupture (from bone fragments)
      1. Management per emergent urology Consultation
  4. Bladder Contusion
    1. Results from direct blow to the suprapubic region
    2. Gross or Microscopic Hematuria (even mild) with Trauma History should prompt Abdominal CT
    3. Place Foley Catheter and start Antibiotics for 7-10 days
  5. Ureteral Injury
    1. May be associated with Pelvic Fractures or Lumbar SpineFractures

IV. Associated Conditions: Male genitourinary

  1. Male Urethral Injury
    1. Symptoms
      1. Urethral or penile pain
      2. Urethral meatus blood
      3. Perineal Ecchymosis
    2. Causes
      1. Pelvic Fracture
      2. Straddle injury to the penis (Bicycling)
    3. Evaluation
      1. Emergently Consult Urology
      2. Retrograde Urethrogram
  2. Scrotal Injury
    1. Direct blunt Scrotal Trauma
    2. Injuries
      1. Scrotal Hematoma
      2. Testicular Contusion
    3. Evaluation
      1. Doppler UltrasoundScrotum if Testicular Pain persists >1 hour
      2. Evaluate for Testicular Torsion or testicular rupture
      3. Testicular Trauma alone is a risk for testicular atrophy and Infertility
    4. Management of negative Ultrasound
      1. Ice to the area for 20 min/hour for 12 to 24 hours
      2. Elevate Scrotum

V. Associated Conditions: Female Genitourinary Trauma

  1. See Pediatric Vaginal Injury
  2. See Sexual Assault
  3. Vulvar Contusion or Vulvar Hematoma
    1. Symptomatic management (NSAIDS, rest, ice to the area)
  4. Vaginal Water Insufflation
    1. Water may be forced into vagina in certain water activities (e.g. water Skiing)
    2. High pressures may result in vaginal Lacerations
    3. Lake water may enter the Uterus and fallopian tubes and result in infection (e.g. Endometritis)

VI. Precautions

  1. Do not insert Foley Catheter if Urethral blood, scrotal Hematoma or high riding Prostate
  2. As with Abdominal Trauma, avoid unnecessary studies that delay exploratory laparoscopy when it is clearly indicated

VII. Imaging: Preferred Studies

  1. Most studies have been replaced by CT Abdomen and Pelvis
  2. CT Abdomen and Pelvis Indications
    1. First-line preferred study
    2. Indicated for Pelvic Fracture evaluation as well as free peritoneal fluid and retroperitoneal fluid evaluation
    3. Perform with IV Contrast (administer with Oral Contrast and possibly rectal contrast if time allows)
  3. Retrograde Urethrogram Indications
    1. Perineal or scrotal Hematoma
    2. Blood at uretheal meatus
    3. High riding Prostate
    4. Pelvic Fracture or Pubic Symphysis Diastasis suspected
    5. Inability to void

VIII. Imaging: Other studies

  1. XRay Pelvis
    1. Evaluate for Pelvic Fracture in cases of benign Abdomen in which CT Abdomen and Pelvis was not initially indicated
  2. Intravenous pyelogram
    1. CT Abdomen and Pelvis is preferred
    2. Demonstrates Renal Function as well as dye extravasation in cases of urinary tract disruption
    3. Indications
      1. Hematuria
      2. Flank injury or mass
      3. Absent psoas shadow
      4. Lower bony thorax injury

IX. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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