Lower Genitourinary Trauma Treatment & Management

  • Author: Imad S Dandan, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 7, 2011
 

Prehospital Care

Advancement of prehospital care for the trauma patient is one of the biggest leaps forward in trauma care. Principles do not change with varying organ injuries.[3, 11]

Paramedics quickly assess the patient and mechanism of injury, especially for 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).
  • Leave the scene as soon as possible and quickly transport the patient to the trauma center.
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Emergency Department Care

  • Administer oxygen and ventilatory support if needed.
  • Resuscitate with crystalloids (lactated Ringer solution or isotonic sodium chloride solution) and blood (O-negative packed red blood cells) if indicated.
  • Treat life-threatening injuries (eg, tension pneumothorax, open pneumothorax, cardiac tamponade) should be addressed emergently in the ED.
  • Use diagnostic procedures as indicated (cystogram and retrograde urethrogram).
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Consultations

  • Trauma surgeon for associated intra-abdominal injuries
  • Urologist for lower GU tract injury
  • Orthopedic surgeon for management of frequently associated pelvic fractures
  • Other specialists as injuries require
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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. Walsh PC. Genitourinary trauma. In: Campbell's Urology. 6th ed. WB Saunders Co; 1992:2574.

  2. Guerriero WG. Trauma to the kidneys, ureters, bladder, and urethra. Surg Clin North Am. Dec 1982;62(6):1047-74. [Medline].

  3. American College of Surgeons Committee on Trauma. Initial assessment and management. Advanced Trauma Life Support Program for Physicians;1993:9-46.

  4. Cutinha P, Chapelle CR. Bladder injuries. Surg Int. 1997;37:107-12.

  5. Png D, Chapelle CR. Urethral injuries. Surg Int. 1997;37:97-101.

  6. James MJ. Investigation of the lower urinary tract. Surgery. 1995;13(2):37.

  7. Peterson NE. Traumatic posterior urethral avulsion. Monogr Urol. 1986;7:61.

  8. Patel A, Harrison SCW. Scrotal trauma. Surg Int. 1997;37:118-20.

  9. Ziran BH, Chamberlin E, Shuler FD, Shah M. Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. J Trauma. Mar 2005;58(3):533-7. [Medline].

  10. Styles RA. Hematuria. Surgery. 1996;14:213.

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

  12. Peterson NE. Current management of urethral injuries. Urol Annual. 1988;143-79.

  13. Ishak C, Kanth N. Bladder trauma: multidetector computed tomography cystography. Emerg Radiol. Apr 27 2011;[Medline].

  14. Krieger JN, Algood CB, Mason JT, et al. Urological trauma in the Pacific Northwest: etiology, distribution, management and outcome. J Urol. Jul 1984;132(1):70-3. [Medline].

  15. Richardson JR Jr, Leadbetter GW Jr. Non-operative treatment of the ruptured bladder. J Urol. Aug 1975;114(2):213-6. [Medline].

  16. Wu TS, Pearson TC, Meiners S, Daugharthy J. Bedside Ultrasound Diagnosis of a Traumatic Bladder Rupture. J Emerg Med. Mar 24 2011;[Medline].

 
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Normal urethrogram.
Retrograde urethrogram showing an irregularity of the urethra indicating injury secondary to a shotgun wound.
Normal bladder on CT scan.
Ruptured dome of urinary bladder detected by retrograde cystogram.
Ruptured urinary bladder detected by CT scan.
Extravasated contrast in abdominal cavity secondary to ruptured bladder.
 
 
 
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