Genitourinary Trauma

GU Basics & Renal Trauma - First Aid & Kidney Cracks

• Primary Survey: ABCDEs. Suspect GU injury with flank pain, tenderness, ecchymosis (Grey Turner's/Cullen's signs), or hematuria.
• Renal Trauma: Most common GU organ injured, primarily by blunt trauma (MVCs, falls).
  • Key Imaging Indications (CT Scan):
    • All penetrating trauma.
    • Blunt trauma with gross hematuria.
    • Blunt trauma with microscopic hematuria AND shock (SBP < 90 mmHg).
    • Major deceleration injuries.
    • Pediatric trauma with >50 RBCs/HPF.

⭐ Hematuria (gross or microscopic) with shock is a strong indicator for renal imaging in trauma.

• Management Principles:
  • Most renal injuries (Grades I-III, select IV) managed non-operatively.
  • Surgery for: hemodynamic instability, Grade V (e.g., shattered kidney, pedicle injury), expanding/pulsatile retroperitoneal hematoma. 📌 SHOCK + HEMATURIA = CT SCAN!

Ureter & Bladder Trauma - Tube Trouble & Tank Tears

Ureteric Injury:

• Causes: Iatrogenic (gynae/colorectal surgery > urologic), penetrating trauma. Blunt (rare).
  • 📌 "Water under the bridge": Uterine artery crosses ureter.
• Sx: Often delayed. Flank pain, fever, urinoma, hematuria.
• Dx: CT urogram (gold standard), retrograde pyelography.
• Mx:
  • Partial: Stenting, primary repair.
  • Complete: Ureteroureterostomy, Boari flap, psoas hitch.

Bladder Injury:

• Assoc. w/ pelvic fractures (~80%).
• Types: Contusion, Extraperitoneal (EPR), Intraperitoneal (IPR).
• Sx: Gross hematuria, suprapubic pain, inability to void.
  • EPR: Localized signs.
  • IPR: Peritonitis.
• Dx: Retrograde cystography / CT cystography.
  • EPR: "Molar tooth" sign (extravasation).
  • IPR: Contrast around bowel.

⭐ Pelvic fracture with gross hematuria strongly suggests bladder injury; cystography is key.

• Mx:
  • Contusion/EPR (uncomplicated): Catheter drainage (7-14 days).
  • IPR/EPR (complicated): Surgical repair.

Urethral & Genital Trauma - Pipe Pain & Parts Predicament

• Urethral Injury:
  • Types: Posterior (pelvic #; prostatomembranous), Anterior (straddle; bulbar/pendulous).
  • Signs: 📌 BUMPH (Blood at meatus, Unable to void, Meatal/perineal swelling, Pelvic fracture, High-riding prostate).

  • ⭐ Blood at the urethral meatus is a cardinal sign of urethral injury; perform Retrograde Urethrogram (RUG) before catheterization.

  • Management:
    • Partial tear: Suprapubic cystostomy (SPC) or gentle catheter. Early endoscopic realignment possible.
    • Complete tear: SPC, then delayed repair (3-6 months). Early endoscopic realignment also an option.
  • Complications: Stricture, incontinence, impotence.
• Penile Fracture:
  • Rupture of tunica albuginea (corpus cavernosum). Audible snap, pain, detumescence, "Eggplant" deformity.
  • Surgical emergency: immediate repair.
• Testicular Trauma:
  • Blunt (common) or penetrating.
  • Dx: Ultrasound (integrity, hematoma).
  • Mgmt: Conservative (contusion/small hematoma). Surgery for rupture/large hematoma.

High‑Yield Points - ⚡ Biggest Takeaways

• Renal trauma: Most common; hematuria is key sign; CT scan for diagnosis.
• Bladder rupture: Suspect with pelvic fractures & gross hematuria; retrograde cystography is diagnostic. Intraperitoneal type needs surgery.
• Posterior urethral injury: With pelvic fractures; blood at meatus, high-riding prostate. RUG confirms.
• Anterior urethral injury: Typically from straddle injury.
• Testicular rupture: Needs surgical exploration; ultrasound aids diagnosis.
• Penile fracture: Tunica albuginea rupture; a surgical emergency_._