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Gen
itouri
nar
y T
raum
a
Intr
od
uct
ion
•G
U T
rau
ma
ov
erlo
ok
ed
•1
0-2
0%
of
all
inju
red
pat
ien
ts
•L
on
g t
erm
mo
rbid
ity
–Im
po
ten
ce
–In
con
tin
ence
•L
ife-
thre
aten
ing
in
juri
es f
irst
Pla
n
•U
reth
ral
Inju
ry
•B
lad
der
In
jury
•K
idn
ey I
nju
ry
Def
init
ion
s
•U
pp
er t
ract
–K
yd
ney
–U
rete
rs
•L
ow
er t
ract
–B
lad
der
–U
reth
ra
•E
xte
rnal
gen
ital
ia
Ure
thra
l T
rau
ma
•A
lmo
st e
xcl
usi
vel
y i
n m
ale
•S
ign
ific
ant
mo
rbid
ity
–S
tric
ture
–In
con
tin
ence
–Im
po
ten
ce
•If
un
reco
gn
ized
:
–C
on
ver
tin
g p
arti
al t
o c
om
ple
te t
ear
–In
accu
rate
ass
essm
ent
of
U/O
An
ato
my
Bla
dder
Sym
physi
s
Pro
stat
ic
Mem
bra
nous
Bulb
ous
Pen
dulo
us
Po
ster
ior
Ure
thra
•V
iole
nt
exte
rnal
fo
rce
•9
0%
of
Po
st:
Ure
thra
In
jury
≅ P
elv
ic #
•5
-25
% o
f P
elv
ic #
= P
ost
erio
r u
reth
ral
inju
ry
Cli
nic
al F
eatu
res
•G
ross
hem
atu
ria
in 9
8%
•In
abil
ity
to
vo
id
•B
loo
d a
t u
reth
ral
mea
tus
•P
elv
ic /
su
pra
pu
bic
ten
der
nes
s
•P
enil
e /
scro
tal
/ p
erin
eal
hem
ato
ma
•B
og
gy
/ h
igh
-rid
ing
pro
stat
e/ i
ll-d
efin
ed
mas
s o
n r
ecta
l ex
amin
atio
n.
Po
ster
ior
Ure
thra
l ru
ptu
re
Fro
m M
cA
nic
h J
W.
In T
an
ag
ho
EA
, M
cA
nin
ch
JW
, ed
ito
rs:
Sm
ith
’s g
en
era
l
uro
log
y,
ed
14
, N
orw
alk
, C
on
n,
19
95
, A
pp
leto
n &
La
ng
e.
Dia
gn
osi
s:
Ret
rog
rad
e U
reth
rog
ram
•P
rete
st K
UB
fil
m
•S
up
ine
po
siti
on
•In
ject
ion
of
25
ml
of
wat
er-s
olu
ble
co
ntr
ast
•D
iffe
ren
t te
chn
iqu
es
Ret
rog
rad
e U
reth
rog
ram
Ret
rog
rad
e U
reth
rog
ram
:
Inte
rpre
tati
on
•C
on
tras
t ex
trav
asat
ion
+ C
on
tras
t in
bla
dd
er
•C
on
tras
t ex
trav
asat
ion
on
ly
PA
RT
IAL
Tea
r
CO
MP
LE
TE
Tea
r
Par
tial
Tea
r
Co
mp
lete
Tea
r
Man
agem
ent
•P
arti
al t
ear
–ca
refu
l p
assa
ge
of
12
-14
Fr.
Fo
ley
.
–If
an
y r
esis
tan
ce:
Uro
log
y
•C
om
ple
te t
ear:
– U
rolo
gy
+ s
up
rap
ub
ic c
ath
.
•If
Fo
ley
alr
ead
y t
her
e an
d s
usp
ect
tear
:
–L
EA
VE
FO
LE
Y I
N P
LA
CE
–S
mal
l tu
be
alo
ng
sid
e th
e fo
ley
–A
ng
ioca
th 1
6-g
aug
e
–M
od
ifie
d u
reth
rog
ram
An
teri
or
Ure
thra
•M
ore
co
mm
on
th
an p
ost
erio
r
•D
irec
t tr
aum
a
•U
sual
ly N
O p
elv
ic F
ract
ure
•B
loo
d a
t m
eatu
s
•U
nab
le t
o m
ictu
rate
•P
enil
e/S
cro
tal/
Per
inea
l
–C
on
tusi
on
–H
emat
om
a
–F
luid
co
llec
tio
n
Sle
eve
Hem
ato
ma
Bu
tter
fly
Hem
ato
ma
An
teri
or
Ure
thra
l R
up
ture
An
teri
or
Ure
thra
:
Man
agem
ent
•N
O F
ole
y i
f in
jury
su
spec
ted
•R
etro
gra
de
Ure
thro
gra
m
•U
rolo
gy
:
–S
urg
ical
Tre
atm
ent
Bla
dd
er T
rau
ma
•A
du
lt:
Ex
trap
erit
on
eal
org
an
•B
lad
der
do
me
= w
eak
est
po
int
•B
lun
t: 6
0-8
5%
•M
VA
: N
o.1
cau
se
•C
om
pli
cati
on
–P
elvic
/abdom
inal
wal
l ab
sces
s/nec
rosi
s
–P
erit
onit
is
–In
tra-
abdom
inal
absc
ess
–S
epsi
s /
Dea
th
Ty
pes
of
rup
ture
Ex
trap
erit
on
eal
–M
ost
co
mm
on
–8
9-1
00
% =
ass
oci
ated
wit
h P
elv
ic F
ract
ure
Intr
aper
ito
nea
l
–E
xtr
avas
atio
n o
f u
rin
e in
ab
do
men
–S
ud
den
fo
rce
to f
ull
bla
dd
er
–A
sso
ciat
ed i
nju
ries
++
+
–M
ort
alit
y (
20
%)
Cli
nic
al P
rese
nta
tio
n
•9
8%
: G
ross
hem
atu
ria
•2
%:
Mic
rosc
op
ic h
emat
uri
a +
Pel
vic
#
•1
00
%:
Gro
ss h
emat
uri
a
•8
5%
Pel
vic
#
• McC
on
nel
et
al.
Ru
ptu
re o
f th
e b
lad
der
. U
rol
Cli
n N
ort
h A
m.
19
82
.
• Car
roll
et
al.
Ma
jor
bla
dd
er t
rau
ma
: M
ech
an
ism
s o
f in
jury
an
d a
un
ifie
d m
eth
od
of
dia
gn
osi
s a
nd
rep
air
. Jo
urn
al o
f U
rolo
gy.
19
84
.
• Mo
rey A
F e
t al
. B
lad
der
ru
ptu
re a
fter
blu
nt
tra
um
a :
gu
idel
ines
fo
r
dia
gn
ost
ic i
ma
gin
g.
Jou
rnal
of
Tra
um
a-In
jury
In
fect
ion
s &
Cri
tica
l
Car
e. 5
1(4
): 6
83
-6,
20
01
Oct
.
Inv
esti
gat
ion
•C
yst
og
rap
hy
: G
old
sta
nd
ard
•C
T C
yst
og
rap
hy
: N
ew t
ren
d
Tre
atm
ent
•P
enet
rati
ng
in
juri
es:
OR
•B
lun
t
–In
trap
erit
on
eal:
Alm
ost
all
OR
–E
xtr
aper
ito
nea
l: U
reth
ral
cath
. d
rain
age
x 7
-10
day
s.
Gro
ss «
Hem
atu
ria
»:
Fal
se +
•A
lph
amet
hy
ldo
pa
•Ib
up
rofe
n
•L
evo
do
pa
•M
etro
nid
azo
le
•N
itro
fura
nto
in
•P
hen
azo
py
rid
ine
•P
hen
olp
hta
lein
-co
nta
inin
g l
axat
ives
•R
ifam
pin
•B
eets
/ber
ries
Kid
ney
In
jury
•R
etro
per
ito
nea
l o
rgan
•C
ush
ion
ed b
y p
erin
eph
ric
fat
•G
ero
ta’s
fas
cia
•A
lon
g T
10
- L
4
•R
ibs
10
-12
•F
ixed
on
ly t
hro
ug
h p
edic
le.
•1
.2L
of
blo
od
/ m
in
Kid
ney
In
jury
…
•B
lunt
trau
ma:
80
-90
%
•R
apid
dec
eler
atio
n /
Dir
ect
blo
w
•M
US
T b
e su
spec
ted
if
1. T
rau
ma
to b
ack /
fla
nk
/ l
ow
er t
ho
rax
/
u
pp
er a
bd
om
en
2. F
lank
pai
n /
Hem
atu
ria
/ E
cch
ym
osi
s o
ver
th
e fl
ank
s
3. lo
w r
ib F
ract
ure
4. L
um
bar
tra
nsv
erse
pro
cess
Fra
ctu
re
Cla
ssif
icat
ion
of
Inju
ry
•5
Cla
sses
of
Ren
al I
nju
ry :
Org
an I
nju
ry S
cali
ng
Co
mm
itte
eM
oore
et
al.
Org
an I
nju
ry S
cali
ng:
Sle
en,
Liv
er a
nd K
idney
, T
he
Journ
al o
f T
raum
a,
29:
1664;
1989.
Gra
de
I
•C
on
tusi
on
–H
emat
uri
a
–U
rolo
gic
stu
die
s N
•H
emat
om
a
–S
ubca
psu
lar
–N
on e
xpan
din
g
–P
aren
chym
a N
Gra
de
II
•H
emat
om
a
–P
erir
enal
–N
onex
pan
din
g
•L
acer
atio
n
–<
1.0
cm
–R
enal
cort
ex o
nly
–N
o u
rinar
y
extr
avas
atio
n
Gra
de
III
•L
acer
atio
n
–>
1.0
cm
–R
enal
cort
ex o
nly
–N
o u
rinar
y e
xtr
avas
atio
n
–In
tact
coll
ecti
ng s
yst
em
Gra
de
IV
•L
acer
atio
n
–R
enal
cort
ex
–R
enal
med
ull
a
–C
oll
ecti
ng s
yst
em
•V
ascu
lar
–M
ain r
enal
art
ery/v
ein
inju
ry w
ith c
onta
ined
hem
orr
age.
Gra
de
V
•C
om
ple
tely
sh
atte
red
kid
ney
.
•A
vu
lsio
n o
f re
nal
hil
um
(p
edic
ule
)
wh
ich
dev
ascu
lari
zes
kid
ney
.
Ken
non e
t al
. R
adio
gra
phic
ass
essm
ent
of
renal
tra
um
a: o
ur
15-y
ear
exper
ience
. T
he
Journ
al o
f T
raum
a, 1
54:
353-3
55;
August
1995.
Ped
icu
le I
nju
ry
Inv
esti
gat
ion
•IV
P
–U
sed
to
be
inti
al e
xam
of
cho
ice.
–V
ery
poo
r se
nsi
tiv
ity
fo
r p
enet
rati
ng i
nju
ry
–L
imit
atio
n i
n s
tagin
g r
enal
inju
ries
–N
ot
1st c
hoic
e an
ym
ore
. O
nly
if
pt
unst
able
.
•C
on
tras
t C
T
–S
tudy
of
cho
ice
if s
table
–M
ore
sen
siti
ve
and
sp
ecif
ic f
or
stag
ing
–D
etec
ts o
ther
ab
dom
inal
in
juri
es
Man
agem
ent
•P
enet
rati
ng
tra
um
a:
–Im
agin
g f
or
AL
L (
9%
: N
O h
emat
uri
a)
•B
lun
t tr
aum
a Im
agin
g:
–G
ross
hem
atu
ria
–M
icro
sco
pic
hem
atu
ria
(≥5
RB
C/h
pf)
+
sho
ck (
BP
s≤9
0)
–A
ny
ch
ild
wit
h >
50
RB
C /
hp
f
Man
agem
ent…
•A
bso
lute
in
dic
atio
n f
or
Su
rger
y:
–U
nco
ntr
oll
able
ren
al h
emorr
age
–M
ult
iply
lac
erat
ed, sh
atte
red k
idney
–M
ain r
enal
ves
sels
avuls
ed
–P
enet
rati
ng i
nju
ries
usu
ally
•G
rad
e I-
II–
conse
rvat
ive
•G
rad
e II
I-IV
–C
onse
rvat
ive
if s
table
hem
odynam
ical
ly v
s. s
urg
ery
•G
rad
e V
–S
urg
ery
Gra
de
V
Kozi
n,
Ber
let.
Handbook o
f C
om
mon O
rthopaedic
Fra
ctu
res,
4th e
d.,
2000.
Co
ncl
usi
on
•N
o F
ole
y i
f y
ou
su
spec
t u
reth
ral
trau
ma
•G
ross
hem
atu
ria
OR
mic
roh
emat
uri
a +
Sh
ock
=
GU
Tra
um
a.
•P
elv
ic #
+ M
icro
hem
atu
ria
G
U i
nv
esti
gat
ion
•D
on
’t r
emo
ve
Fo
ley
if
yo
u s
usp
ect
a p
arti
al t
ear
of
ure
thra
aft
erw
ard
s.
•M
icro
hem
atu
ria
alo
ne
: N
o i
mag
ing
…b
ut
F/U
.
•In
ped
s: I
mag
ing
fo
r A
LL
hem
atu
ria.
