Upper Genitourinary Trauma Treatment & Management

  • Author: Imad S Dandan, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 13, 2011
 

Prehospital Care

Advancement of prehospital care for trauma patients is one of the biggest leaps forward in trauma care. Principles do not change with different organ injuries.

Paramedics quickly assess the patient and mechanism of injury, with special attention to patency of ABCs.

  • Establish an airway if needed and/or administer oxygen.
  • Establish 2 large-bore IVs.

Take cervical spine precautions (eg, hard collar, back-board).

Quickly transport the patient to the trauma center.

Next

Emergency Department Care

Adherence to ATLS principles is necessary for proper care of the trauma patient.

  • Administer oxygen and ventilatory support if needed.
  • Resuscitate with crystalloids (lactated Ringer solution or isotonic sodium chloride solution) and blood (O-negative or type-specific blood if known) if indicated.
  • Treat life-threatening injuries (eg, tension pneumothorax, open pneumothorax, cardiac tamponade) should be addressed emergently in the ED.
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Consultations

  • Trauma or general surgeon for management of associated abdominal injuries
  • Urologist for management of specific GU injuries
  • Other specialists as injuries dictate
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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Imad S Dandan, MD  Consulting Surgeon, Department of Surgery, Trauma Section, Scripps Memorial Hospital

Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, American Trauma Society, California Medical Association, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Walid A Farhat, MD, FRCS(C)  Associate Professor, Department of Surgery, University of Toronto; Staff Physician, Division of Urology, The Hospital for Sick Children

Walid A Farhat, MD, FRCS(C) is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, College of Physicians and Surgeons of Ontario, and International Pediatric Endosurgery Group

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Howes, MD  Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Saad DF, Gow KW, Redd D, Rausbaum G, Wulkan ML. Renal artery pseudoaneurysm secondary to blunt trauma treated with microcoil embolization. J Pediatr Surg. Nov 2005;40(11):e65-7. [Medline].

  2. American Association for the Surgery of Trauma. Abstracts, 49th annual session. American Association for the Surgery of Trauma. Chicago, Illinois, October 5-7, 1989. J Trauma. Jul 1989;29(7):1024-40. [Medline].

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  6. American College of Surgeons Committee on Trauma. Pediatric trauma. In: Advanced Trauma Life Support Program for Physicians. 1993:261-281.

  7. Fried FA, Rutledge R. A statewide population-based analysis of the frequency and outcome of genitourinary injury in a series of 215, 220 trauma patients. J Urol. 1995;153:314.

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  13. Mee SL, McAninch JW, Robinson AL, et al. Radiographic assessment of renal trauma: a 10-year prospective study of patient selection. J Urol. May 1989;141(5):1095-8. [Medline].

  14. Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver, and kidney. - Malangoni MA. Dec 1989;29(12):1664-6. [Medline].

  15. Payne SR. Upper urinary tract obstruction. Surgery. 1996;14(12):272.

  16. Peterson NE. Current management of acute renal trauma. Urology Annual. 1991;151-179.

  17. Rosario D, Chapple CR. Trauma to the upper urinary tract. Surgery Int. 1997;37:113-20.

  18. Sagalowsky AI, McConnell JD, Peters PC. Renal trauma requiring surgery: an analysis of 185 cases. J Trauma. Feb 1983;23(2):128-31. [Medline].

  19. Sturm JT, Perry JF Jr, Cass AS. Renal artery and vein injury following blunt trauma. Ann Surg. Dec 1975;182(6):696-8. [Medline].

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  21. Trunkey D. Initial treatment of patients with extensive trauma. N Engl J Med. May 2 1991;324(18):1259-63. [Medline].

 
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Ruptured left kidney.
Avulsed left renal artery with thrombosis.
CT scan of abdomen and pelvis showing a urinoma.
Urinoma by CT.
Lateral view of a urinoma.
Contrast-filled urinoma.
Retrograde urethrogram showing a leak in the distal right ureter with an element of obstruction.
 
 
 
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