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Urinary tract and groin trauma (Renal (Diagnosis (Examination Abdo:…
Urinary tract
and groin trauma
Renal
Clinical presentation
Loin pain
Haematuria
Diagnosis
Examination
Abdo: bruising/abraisions, local tenderness,
loin swelling/mass if haematoma
Investigations
Urine: dipstick (haematuria, may be -ve if severe injury with
renal vascular tear/ureteric avulsion/thrombosis)
Bloods: crossmatch/G+S, clotting, FBC, U+E, LFTs glucose
Imaging: FAST scan, abdo CT + contrast
History
HPC/PC: blow to flank, then
pain and delayed haematuria
Pathophysiology
Direct blunt abdo trauma with kidneys crushed against the paravertebral muscles, ribs, spine
Indirect trauma to the supplying vessels, or ureters at PUJ
Can lead to renal ischemia
Penetrating injuries rare
Associated other injuries common
Management
Initial ABCDE
Definitive
Medical
Analgesia
Abx (prophylaxis)
Surgical
Indication: penetrating injury, severe blunt trauma
MOA: urgent exploratory urological assessment
NB ischemic time of kidney only 2h!
Conservative
Bed rest
Regular obs (urine, BP, HR, temp etc.)
Bladder
Clinical presentation
Lower abdominal pain, reduced urine output
Diagnosis
History
Abdo trauma
Examination
Abdo: tenderness, peritonism, bruising
Genitals: perineal bruising, haematuria,
blood in external urethral meatus
PR: position of prostate, rectal integrity
Investigations
Bedside: obs, ECG
Bloods: group+save, FBC, U+Es, clotting
Urine: dipstick (haematuria)
Imaging: AXR, pelvis XR, cystogram
Pathophysiology
Direct trauma to abdomen can cause rupture into
the peritoneal cavity
Bone fragments can penetrate the bladder
Management
Medical
May need abx
Surgical
Indication: intraperitoneal rupture
MOA: laparotomy and repair
Conservative
Urology referral
Catheterise if no UO to drain
Urethra
Clinical presentation
Abdominal/peritoneal pain, reduced UO
Diagnosis
History
Pelvic/perineum trauma
Examination
Genitals: perineal bruising, blood external urethral meatus
PR: displaced prostate (high riding)
Investigations
Bedside - obs
Bloods - usual
Imaging: AXR/pelvic XR, retrograde urethrogram
Pathophysiology
Pelvic fractures or blows to the perineum
Management
Conservative
Urology referral
Suprapubic catheterisation
Surgical
Surgical repair
Testicle
Clinical presentation
Pain, bruising, swelling
Diagnosis
History
Trauma
Examination
Genital exam, PR
Investigations
Bedside - obs
Bloods - normal
Imaging - USS (tell rupture
from haematoma)
Pathophysiology
Blunt or penetrating trauma
Rupture or haematoma
Management
Consevative
Urology referral
Medical
Analgesia
Surgical
I+D (haematoma)
Surgical exploration and repair (rupture)
Scrotum
Clinical presentation
Pain
Diagnosis
Examination
Genitals: signs of trauma
PR: nil
Investigations
Bedside: obs
Bloods: normal
Imaging: USS testes
History
Trauma
Pathophysiology
Blunt or penetrating trauma
Management
Conservative
Urology referral
Medical
Sutures
Surgical
Indication: scrotal penetration
Method: surgical exploration of testes,
epididymis and vas deferens
Penile
Clinical presentation
Minor tear: pain and bleeding
Fracture: penile swelling, tenderness
Diagnosis
History
Trauma post-SI
Examination
Genital: minor tear, visible bleeding,
swelling, tender to palpation
Pathophysiology
Minor tears of the frenulum, often post-SI
Penile fracture (tunica albuginea injury of erect penis)
Management
Medical
Analgesia
Surgical
Indication: penile fracture
Method: urgent exploration,
haematoma evacuation
and surgical repair
Conservative
Urology referral
Local pressure to bleeding tear