Genitourinary Trauma

Renal Injury
Bladder Injury
Ureteral Injury
Urethral Injury
External Genital
Injury

Renal Injury
RED FLAGS Answer
Hematuria (not always!)
CT contrast
Flank pain/ecchymoses
Lower rib fx Consult
Lumbar transverse process fx
Penetrating flank injury
Most blunt renal trauma is non operative
 Perinephric blood

Renal Contusion

Bladder Injury
Red Flags Answer

Pelvic fracture Retrograde

+ cystogram
Gross Hematuria Consult
Suprapubic pain
Inability to void

FAST/CT not sensitive for bladder rupture

INTRA- peritoneal
inside peritoneum

BAD= OR

EXTRA-peritoneal
outside peritoneum

Not BAD = observe, catheter

Ureteral Injury

Rare Answer
● CT
(due to retroperitoneal protection)
w/contrast
Penetrating Trauma ● CT urogram
● Retrograde
+/- flank pain pyelography
< 50% have hematuria ● Consult

ALL URETERAL INJURIES ⇨ OR

Urethral Injury
Red Flags Answer
● Pelvic fracture ● NO FOLEY
● HEMATURIA ● RUG
● BLOOD AT MEATUS ● CT cystogram
● Inability to void ● Consult
● Boggy prostate
● Perineal bruising

♀= rare, short and mobile

posterior

urogenital
diaphragm
anterior
Urethral Injury
Anterior Posterior
● Straddle injury ● Pelvic fracture
● Hematuria ● Distended bladder
● Swollen penis/scrotum ● Normal penis
● Complications: ● High-riding prostate
○ Fistula/Stricture ● Complications:
○ Impotence/incontinence
⇩
OR ⇩
Suprapubic catheter
Delayed surgery

Suprapubic Catheter
RED FLAGS Indications
● Urethral injury ● Need to decompress
● Urethral stricture bladder
● Urinary retention ● Cannot pass foley

External Genital Injury

Scrotal/Testicular Answer

● Straddle injury ● Doppler US

● Hematuria
● Scrotal ecchymosis ● Consult
● Scrotal hematoma
● Testicular tenderness
Complications: abscess, infertility, hydrocele
 Penile Injury Vaginal Injury
● Crack/pain ● Consider abuse
● Detumescence ● Sexual Assault Exam
● “Egg plant”
● Blunt (eg. straddle)
● ⅓ with urethral
rupture ● Penetrating – look
for laceration, rectal
involvement

Image Attribution
Abdotrauma by James Heilman, MD is licensed under CC BY-SA 3.0

Male and female anatomy by Tsaitgaist is licensed under CC BY-SA 3.0

Injury balls by Gobbsession is licensed under CC BY 4.0

Penile fracture by M213m213 is licensed under CC BY 4.0