Emerg Radiol (2009) 16:21–33 DOI 10.1007/s10140-008-0738-x
PICTORIAL ESSAY
Genitourinary trauma: a pictorial essay R. N. Srinivasa & S. A. Akbar & S. Z. Jafri & G. A. Howells
Received: 4 April 2008 / Accepted: 5 May 2008 / Published online: 12 June 2008 # Am Soc Emergency Radiol 2008
Abstract Genitourinary trauma is often overlooked in the setting of acute trauma. Usually other more life-threatening injuries take precedence for immediate management. When the patient is stabilized, radiologic imaging often plays a key role in diagnosing insults to the upper and lower genitourinary tract in the setting of trauma. Our aim is to provide a pictorial assay of imaging findings in upper and lower tract genitourinary trauma from a variety of mechanisms including blunt trauma, penetrating trauma, and iatrogenic trauma. A patient archiving and communication system will be used to review imaging studies of patients at our institution with genitourinary tract trauma. Cases of renal, ureteral, bladder, urethral, penile, and scrotal trauma will be considered for inclusion in our study. Multimodality imaging techniques will be reviewed. The imaging and pertinent findings that occur in various types of genitourinary trauma are outlined. Genitourinary trauma is often missed in the frenzy of acute trauma. It is important to have a high suspicion for injury especially in severe trauma, and in particular clinical settings. Although often not life threatening, recognizing the diagnostic imaging findings quickly is the realm of the astute radiologist so appropriate urologic management can be made. Keywords Genitourinary . Trauma . Renal . Ureter . Scrotum . Bladder . Adrenal
R. N. Srinivasa (*) : S. A. Akbar : S. Z. Jafri : G. A. Howells William Beaumont Hospital, Royal Oak, MI, USA e-mail:
[email protected]
Introduction Genitourinary trauma is often overlooked in the setting of acute trauma. Usually other more life-threatening injuries take precedence for immediate management. When the patient is stabilized, radiologic imaging often plays a key role in diagnosing insults to the upper and lower genitourinary tract in the setting of trauma. The following is a pictorial assay of imaging findings in upper and lower tract genitourinary trauma from a variety of mechanisms including blunt trauma, penetrating trauma, and iatrogenic trauma.
Imaging features Adrenal Adrenal hemorrhage is a relatively uncommon condition with a variable and non-specific presentation that may lead to acute adrenal crisis, shock, and death unless it is recognized promptly and treated appropriately. Patients with traumatic adrenal hemorrhage are usually in the second to the third decade of life. Blunt trauma of diverse etiologies has been associated with bilateral adrenal hemorrhage; however, hemorrhage is unilateral in more than 90% of cases of blunt trauma. Symptoms of adrenal hemorrhage are non-specific, including abdominal, lumbar, pelvic, or thoracic pain and symptoms of acute adrenal insufficiency, such as fatigue, anorexia, nausea, and vomiting. Pain that is non-specific in location and quality is the most consistent feature of adrenal hemorrhage. It can occur predominantly in the epigastrium, flank, upper or lower back, pelvis, precordium, or elsewhere in the thorax. Left shoulder pain also may occur in association with abdominal pain because of diaphragmatic irritation. Fatigue, anorexia,
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nausea, and vomiting, which are present in approximately 50% of extensive bilateral adrenal hemorrhage cases, may be associated with acute adrenal insufficiency. Fever (temperature >38°C) is present in 50–70% of patients with adrenal hemorrhage, representing the most frequent finding in adrenal hemorrhage. Tachycardia has been reported in approximately 40–50% of patients early in the course of extensive bilateral adrenal hemorrhage, and it may progress to shock without aggressive therapy. Signs of acute abdomen, including guarding, rigidity, or rebound tenderness, have been reported in 15–20% of patients. This relative paucity of physical findings on abdominal examination is secondary to the retroperitoneal location of the adrenals. Unilateral adrenal hemorrhage secondary to blunt trauma more often involves the right adrenal. Unilateral adrenal injuries usually have limited clinical significance and are often incidentally diagnosed with computed tomography (CT) following blunt abdominal trauma. Adrenal hemorrhage is often accompanied by other intraabdominal, retroperitoneal, or intrathoracic injuries including liver hematomas and rib fractures. Unilateral adrenal hemorrhage occurs in 2% of patients with penetrating trauma. As far as imaging modalities are concerned, CT is the most accurate method to detect adrenal injury (Fig. 1). Renal Most renal trauma occurs as a result of blunt trauma. Renal injuries may be divided into three groups: renal laceration, renal contusion, and renal vascular injury. Renal trauma accounts for approximately 3% of all trauma admissions and as many as 10% of patients who sustain abdominal trauma. Major mechanisms that generate renal injuries include: penetrating (gunshot wounds, stab wounds), blunt (pedestrian struck, motor vehicle crash, sports, fall), iatrogenic (endourologic procedures, extracorporeal shockwave lithotripsy, renal biopsy, percutaneous renal proce-
Table 1 Categorization of renal injuries [1]
Fig. 1 a–c A 28-year-old male who was involved in a motor vehicle collision. Contrast-enhanced CT abdomen and pelvis reveals hypodensity and lack of enhancement of the left upper pole kidney likely secondary to a vascular injury (segmental renal infarct). There is a minimal amount of fluid around the left kidney. Additionally, there is fluid in the region of the right adrenal gland which measures 35– 45 HU likely representing an adrenal hematoma. This patient was managed non-operatively
Category
Description
I
Minor injury (renal contusion, intrarenal and subcapsular hematoma, minor laceration with limited perinepheric hematoma without extension to the collecting system or medulla, small subsegmental cortical infarct) Major injury (major renal laceration through the cortex extending to the medulla or collecting system with or without urine extravasation, segmental renal infract) Catastrophic injury (multiple renal lacerations, vascular injury the renal pedicle) Ureteropelvic junction injury (evulsion [complete transection], laceration [incomplete tear])
II
III IV
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Most blunt renal injuries are low grade and are usually amenable to treatment with observation and bed rest alone. Serious renal injuries are frequently associated with injuries to other organs. The vast majority of isolated renal injuries are classified as minor injuries. Penetrating trauma is more likely to be associated with more severe renal injury, requiring a higher index of clinical awareness. Penetrating trauma is more often associated with other abdominal injuries requiring laparotomy allowing the opportunity for intraoperative renal staging and repair. Patients with indications for emergent exploration include those with hemodynamic instability. Expanding hematomas or active hemorrhage suggests the possibility of high grade renal injury. Patients with penetrating trauma who are stable and do not require urgent laparotomy for other possible intraabdominal injuries may be observed without immediate renal exploration. Unrelenting gross hematuria may require urgent exploration. However, the
Fig. 2 a–c A 69-year-old male status post-nephrostolithotomy 8 days prior with dropping hemoglobin. CT angiography reveals a large subcapsular hematoma which causes mild extrinsic compression of the left kidney and mild delay of contrast enhancement. There is also a thickening of the Gerotas’s fascia. The left renal artery and vein are patent. These findings were a result of a traumatic nephrostolithotomy
dures), intraoperative (diagnostic peritoneal lavage), and miscellaneous (renal transplant rejection, childbirth [may cause spontaneous renal lacerations]). Patients with preexisting renal abnormalities are at increased risk for injury.
Fig. 3 a–b A 20-year-old male history of trauma. Contrast-enhanced CT through the kidneys reveals an area of decreased perfusion in the left upper medial left kidney which was related to renal laceration. There is hemoperitoneum from the patient’s known liver laceration not pictured here. This patient was managed non-operatively and did well
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presence of a renal contusion does not typically require specific intervention. Most renal contusions resolve, particularly if the lesion appears to be of grade I–III. From a radiologic point of view, renal injuries are divided into four categories as shown in Table 1 [1]. CT has replaced intravenous urography as the primary modality for the assessment of suspected renal injury and has become the imaging method of choice for the assessment of blunt abdominal injuries in major American and European trauma centers (Figs. 2, 3, 4, 5, 6 and 7). Additionally, the use of arteriography in the assessment of renal injuries has diminished because most vascular injuries can be assessed with CT. Ureter Ureteral injuries due to external trauma are rare as the ureter is well protected in the retroperitoneum by the bony pelvis, psoas muscle, and vertebrae. Any damage to the ureter must come from a significant traumatic event that almost always occurs with collateral injury. Much of the presentation and management of ureteral injuries are dictated by the severity and management of the associated injuries. The ureter is involved in less than 1% of all genitourinary injuries caused by external trauma. Iatrogenic causes aside, the ureter can be injured by penetrating (gunshot wounds, stab wounds) or blunt trauma. The relative predominance of ureteral injury associated with gunshot wounds is reflected in the characteristics of the blast injury. The bullet can
Fig. 5 a–b A 56-year-old male with history of trauma. Contrastenhanced CT reveals a focal area of low attenuation in the anterior margin of the left kidney (renal laceration) with a minimal amount of fluid surrounding it (a). There is also a small posterior subcapsular hematoma in the left kidney at a lower level (b). The patient was managed non-operatively
Fig. 4 A 72-year-old female status post-cardiac cath and coronary stent placement. Contrast-enhanced CT reveals a large right perirenal and retroperitoneal hematoma. There is a dense nephrogram of the right kidney which may be related to compression of the right ureter or renal vein by hemorrhage. The retroperitoneal hematoma involves the perirenal, anterior pararenal, as well as the posterior pararenal spaces
Fig. 6 a–c A 34-year-old female who was pinned between a tree and b a car. Contrast-enhanced CT of the abdomen and pelvis reveals contrast enhancement of the left kidney without enhancement of the right kidney. Associated fluid is seen surrounding the right kidney which is complex in density and compatible with hemorrhage. The origin of the right renal artery is seen and appears truncated compatible with disruption of the right renal artery. There is a hypodense filling defect in the aorta which indicates thrombosis or aortic injury as well. No enhancement of the right adrenal gland is also demonstrated which is on the basis of an adrenal injury. Non-contrast images were not obtained. The patient underwent urgent surgical intervention and had a right nephrectomy. The right adrenal gland was left in place
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damage the ureter via direct transection, or the blast injury may disrupt the intramural blood supply, resulting in ureteral necrosis. Fortunately, fewer than 3% of gunshot injuries involve the ureters. The incidence of ureteral injury is even less common with stab wounds. Nevertheless, its involvement should always be considered when the weapon used is a long-blade knife to the abdomen or when any stab
Fig. 7 a–c A 30-year-old male involved in a motorcycle accident. Triple phase CT through the kidneys reveals normal enhancement of the left kidney. There is an area of hypodensity in the posterior right kidney compatible with a parenchymal laceration. Surrounding high density material is compatible with perinephric hematoma. No evidence for urinary extravasation. This patient was managed nonoperatively
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Fig.
8 a–h A 17-year-old female involved in high-speed T-bone motor vehicle collision. Contrast-enhanced CT reveals extensive fracture of the left kidney with lacerations extending into the renal hilum. Large associated hemorrhages are seen in the perinephric and pararenal spaces. Non-enhancing portions of the upper pole left kidney are due to devascularization or segmental infarcts. Contrast extravasation along the proximal portion of the left ureter is due to extension of the laceration into the renal pelvis or intrarenal collecting system. There is hyperdensity along the left anterior psoas which likely represents a combination of hemorrhage or urinary extravasation (non-contrast imaging was not performed at the time of acquisition). Cystogram demonstrates intra- and extraperitoneal bladder rupture. Delayed post-cystogram CT demonstrates extensive intraperitoneal contrast from the cystogram compatible with intraperitoneal bladder rupture. Extensive extraperitoneal extravasation of contrast material is seen with free fluid through the pelvis. On exploratory laparotomy, a splenic laceration, grade IV left kidney laceration, and intra- and extraperitoneal bladder rupture were seen. There was difficulty with repair secondary to multiple coexisting pelvic fractures
wound is posterior to the midaxillary line. Unlike most gunshot injuries, stab wounds usually involve only a short segment of ureter. Blunt trauma may result in ureteral injury from several mechanisms. These mostly involve deceleration or acceleration mechanisms with sufficient momentum to allow the ureter to be disrupted from its fixed points at the ureteropelvic and ureterovesical junctions. Such mechanisms include high-speed motor vehicle collisions or falls from a height. Other mechanisms include a direct blow to L2–3. A sudden cephalad movement of the kidney with downward movement of the ureter may result in an avulsion at the ureteropelvic junction. Recognizing ureteral trauma due to external violence may be difficult. These patients are
Fig. 9 An 83-year-old male with history of recent bladder instrumentation. Contrast-enhanced pelvis CT reveals an irregular fluid collection in the right lower pelvis adjacent to the bladder which is predominantly contrast-filled with a visualizable tract seen connecting between the bladder and the urinoma. This collection was subsequently drained under CT guidance
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usually critically ill and have multiple associated injuries. The diagnosis of ureteral injury may be delayed because of the severity of the other associated injuries. A high index of suspicion is mandatory. In many cases of iatrogenic ureteral trauma, the injury remains unrecognized and patients present with fever, loin pain, fistula formation or signs of infection, or obstruction. Once the diagnosis is suspected, it is best confirmed by retrograde pyelography. CT urography is the modality often used for the evaluation of ureteral trauma, as the integrity of other organs can be assessed simultaneously. CT images should be obtained in the excretory phase of contrast excretion in order to visualize the collecting system and the ureter. In cases of blunt trauma, the diagnosis is usually suspected on the basis of CT findings showing extravasation of contrast material. There is a spectrum of ureteral injury which can range from contusion to partial tear to complete disruption. Rarely, the ureter distal to the ureteropelvic junction can be injured as a result of blunt trauma forces because of puncture of bony fragments. It is important to assess the integrity of the ureter below the level of injury to plan an adequate treatment. A partial tear can be managed with ureteral stenting, whereas a complete disruption will necessitate an open repair (Fig. 8).
Fig. 10 A 21-year-old female in T-bone motor vehicle collision. Portable supine view of the pelvis following the administration of intravesical contrast demonstrates what was felt to be an intra- and extraperitoneal bladder rupture. Multiple pelvic fractures and diastasis of the pubic symphysis were noted. Patient was immediately taken to the OR and was noted to have multiple injuries including retroperitoneal hematoma, splenic injury, and bladder rupture. No additional imaging was obtained. The patient expired secondary to massive blood loss
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Fig. 11 a–b A 40-year-old female struck by a car while riding a motorcycle. Voiding cystogram demonstrates frank extravasation of contrast from the urinary bladder eccentric to the left. Extraperitoneal
contrast material was seen extravasating into the soft tissue structures of the upper left thigh. No definite intraperitoneal extravasation was seen. Multiple associated pelvic fractures were noted
Bladder
(gross hematuria, suprapubic pain or tenderness, difficulty or inability to void). Most patients with bladder rupture complain of suprapubic or abdominal pain, and many can still void. However, the ability to urinate does not exclude bladder injury or perforation. Hematuria invariably accompanies all bladder injuries. Gross hematuria is the hallmark of a bladder rupture. More than 98% of bladder ruptures are associated with gross hematuria, and 10% are associated with microscopic hematuria. Approximately 10% of patients with bladder ruptures have normal urinalyses. Notably, mucosal lacerations and bladder wall contusions may produce hematuria but are unlikely to cause significant abnormalities by CT or cystography. An abdominal examination may reveal distention, guarding, or rebound tenderness. Absent bowel sounds and signs of peritoneal irritation indicate a possible intraperitoneal bladder rupture. In the setting of a motor vehicle accident or a crush injury, bilateral palpation of the bony pelvis may reveal abnormal motion indicating an open-book fracture or a disruption of the pelvic girdle. Pelvic fractures are frequently associated with bladder injury. If blood is present at the urethral meatus, urethral injury should be suspected. Retrograde urethrogram should be performed to assess the integrity of the urethra before attempting to blindly pass a Foley catheter. Cystography and CT cystography are the frequently employed modalities to evaluate bladder trauma. Intraperitoneal bladder ruptures usually occur at the anatomically weak bladder dome and require surgical repair. Conversely,
Bladder injuries occur as a result of blunt or penetrating trauma. The probability of bladder injury varies according to the degree of bladder distention. A full bladder is more likely to become injured than an empty one. Bladder injury from a motor vehicle accident may occur from direct impact with the car or indirectly from the steering wheel or seatbelt. Deceleration injuries of the urinary bladder usually result from falling from a great height and landing on unyielding ground. Assault to the lower abdomen by a sharp kick or blow may result in a bladder perforation. Penetrating injuries to the bladder usually result from high velocity gunshots or sharp stab wounds to the suprapubic area. Of all bladder injuries, 60–85% are from blunt trauma and 15–40% are from a penetrating injury. Of traumatic ruptures, extraperitoneal bladder perforations account for 50–71%, intraperitoneal accounts for 25–43%, and combined perforations account for 7–14%. Incidence of intraperitoneal bladder ruptures is significantly higher in children because of the predominantly intraabdominal location of the bladder prior to puberty. Combined intraperitoneal and extraperitoneal ruptures account for approximately 10% of all traumatic bladder-perforating injuries. Iatrogenic causes include surgical misadventures from gynecologic, urologic, and orthopedic operations near the urinary bladder. Less common causes involve obstetric trauma. Clinical signs of bladder injury are relatively nonspecific; however, a triad of symptoms is often present
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Fig. 12
a–c A 20-year-old male with history of T-bone motor vehicle collision. Contrast-enhanced CT of the abdomen and pelvis demonstrates irregularity of the bladder wall anteriorly with a large amount of surrounding free fluid and extravasating intravesical contrast suspicious for a bladder rupture. Associated extraluminal air is also seen. Cystogram demonstrates right superior and inferior pubic rami fractures and an intra- and extraperitoneal bladder tear most severe on the left compared to the right. Delayed images demonstrate intra- and extraperitoneal rupture of the bladder with contrast extravasating beneath the urethral diaphragm compatible with a grade III tear according to the Goldman classification system [4]
most cases of extraperitoneal bladder rupture are treated with bladder drainage; however, large tears may also require surgical repair (Figs. 9, 10, 11, 12 and 13). Urethra Most urethral injuries are associated with well-defined events, including major blunt trauma such as caused by motor vehicle accidents or falls. Most urethral injuries occur in men but have been described in women, particularly with major perineal soft tissue and vaginal injury. Penetrating injuries in the area of the urethra may also cause urethral trauma. Iatrogenic injury to the urethra from traumatic catheter placement, transurethral procedures, or dilation is not uncommon. Urethral injuries can be classified into two broad categories based on the anatomical site of the trauma. Posterior urethral injuries are located in the membranous and prostatic urethra. These injuries are most commonly related to major blunt trauma such as motor vehicle accidents and major falls. They are most commonly associated with pelvic fractures. Injuries to the anterior urethra are located distal to the membranous
Fig. 13 A 61-year-old female with history of trauma. Contrastenhanced CT reveals extrusion of the anterior bladder through a diastatic pubic symphysis
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Fig.
14 a–c A 32-year-old male with history of trauma during intercourse. Retrograde urethrogram reveals extravasation from the distal penile urethra into the corpus spongiosum and corpora cavernosa with extravasation into the penile veins. Extraurethral contrast is noted posteriorly in a scattered amorphous fashion, likely representing contrast within and outlining the ejaculatory ducts and seminal vesicles. Intraoperatively, the distal urethra was found to be injured compatible with our findings. The posterior urethra appeared intact as expected
urethra. Most anterior urethral injuries come from blunt trauma to the perineum (straddle injuries), and many have delayed manifestation, appearing years later as a stricture. External penetrating trauma to the urethra is rare, but iatrogenic injuries are quite common in both segments of the urethra. Most are related to difficult urethral catheterizations. Posterior urethral injuries are most commonly associated with pelvic fracture, with an incidence of 5– 10%. In the posterior urethra, blunt injuries are almost always related to massive deceleration events such as falls from some distance or vehicular accidents. These patients most often have a pelvic fracture involving the anterior pelvis. Blunt injury to the anterior urethra most often occurs from a blow to the bulbar segment such as what occurs when straddling an object or from direct strikes or kicks to the perineum. Blunt anterior urethral trauma is sometimes observed in the penile urethra in the setting of penile fracture. Penetrating trauma most often occurs to the penile urethra. Etiologies include gunshot and stab wounds. Iatrogenic injuries to the urethra occur when difficult urethral catheterization leads to mucosal injury with subsequent scarring and stricture formation. Transurethral procedures such as prostate and tumor resections and ureteroscopy can also lead to urethral injury. Symptoms include hematuria or inability to void. Physical examination may reveal blood at the meatus or a high-riding prostate gland upon rectal examination. Extravasation of blood along the fascial planes of the perineum is another indication of injury to the urethra. Imaging assessment of the urethra should precede cystography, which should not be performed until after pelvic arteriography if indicated. The Goldman classification is traditionally used for the categorization of urethral injuries ranging from type I to V [4] (Figs. 14 and 15). Scrotum A wide variety of traumatic mechanisms have been reported to result in scrotal trauma, with a common endpoint of blunt and/or penetrating trauma to the scrotal area. In all cases but avulsion, this trauma manifests as scrotal swelling with intratesticular and scrotal hematoma and various
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if repaired within 72h. Failure to promptly diagnose a testicular rupture can result in atrophy, abscess formation, and chronic pain. Immediate presentation is the standard for penetrating wounds, but blunt force trauma frequently has a delayed presentation if it is not associated with testicular dislocation or multisystem injury. The topic of scrotal trauma includes: scrotal injury avulsions, blunt and penetrating trauma, and injury to scrotal contents (testes, epididymis, spermatic cord
Fig. 15 a–b A 59-year-old male with history of trauma and multiple pelvic fractures. Radiopaque arrows were placed 1 cm apart on a piece of tape and affixed to the skin in the area of interest (the arrows will be referred to counting from the uppermost arrow down). Retrograde urethrogram reveals extravasation of contrast material to the adjacent soft tissues in the region of the bulbous urethra. This is at the level of the second arrow. Subsequently a cystogram was performed via injection of contrast through a suprapubic catheter. Just distal to the membranous and bulbous urethra, there is extravasation of contrast into the adjacent soft tissues at the level between the first and second arrows compatible with a 1- to 2-cm separation of the transected urethra
degrees of scrotal wall ecchymosis. A clinical assessment of the extent and the type of the scrotal injury is difficult, particularly for distinction between uncomplicated hematocele and testicular rupture. This distinction is fundamental because a ruptured testis can be salvaged in 90% of patients
Fig. 16 a–b A 17-year-old male who was riding a BMX bike and hit bar with perineum area. He presented with severe pain and swelling in the left testicle. Scrotal ultrasound reveals hypoechoic area in the inferior aspect of the left testicle without flow within it compatible with a focal intratesticular hematoma. Scrotal swelling and edema is seen
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Fig. 17
a–c A 12-year-old male with scrotal trauma. Patient jumped into a swimming pool and landed on other child’s head. Scrotal ultrasound reveals asymmetrically enlarged left testicle with diffuse heterogeneity and multiple focal hypoechoic areas within it. Complex fluid is seen surrounding the left testicle. Scrotal wall edema and thickening is seen. Flow is normal. These findings were compatible with a large intratesticular hematoma with surrounding hemorrhage
contents, urethra). Scrotal trauma accounts for less than 1% of all traumas in the USA annually. The peak age range for this injury is 10–30years. The right testis is injured more often than the left because of the greater possibility of trapping it against the pubis (70% higher riding). Sonography is the imaging modality of choice in the setting of acute scrotal trauma (Figs. 16 and 17).
Management of genitourinary trauma Radiographic assessment 1. Computed tomography (CT) scan to assess kidney function and injury stage assessment 2. Intravenous pyelogram for assessment of severity of kidney injury 3. Angiography for assessment of renal injury and possible embolization 4. Cystogram for assessment of extravasation following bladder trauma Non-surgical management 1. Embolization for treatment of renal vascular injuries in hemodynamically stable patients 2. Transurethral and suprapubic catheterization for drainage following bladder trauma 3. Conservative management with supportive care Surgical management 1. 2. 3. 4. 5. 6.
Renal vascular control Revascularization following renal trauma Laparotomy for assessment of severity of kidney injury Nephrectomy following severe kidney injury Cystostomy following bladder trauma Immediate urethral realignment and delayed urethroplasty following urethral trauma 7. Pedicle control in renal trauma Indications for surgical management of renal trauma Most grade I–IV renal injuries can be managed nonoperatively. The absolute indications for surgery include
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renal pedicle injury, shattered kidney, expanding hematoma, and hemodynamic instability. Relative indications for surgery include persistent extravasation, loculated fluid collections, and incomplete grading by radiographic assessment. The presence of a devitalized renal segment in the setting of other intraabdominal trauma is also a relative indication for surgical intervention [2, 6, 10].
Conclusion Genitourinary trauma is often discovered late in the setting of acute trauma due to the presence of more life-threatening injuries. It is true that injuries to the genitourinary tract are often present in the setting of more severe traumas as opposed to milder ones. Their discovery often hinges on an astute clinical exam by the emergency physician, but often may be an incidental finding on an imaging study ordered for some other reason. Currently, computed tomography is the mainstay of diagnostic assessment for genitourinary tract trauma. Particularly in the setting of renal trauma, it allows for the rapid categorization of the injury and determination of whether or not there is injury to the renal collecting system, crucial for therapeutic and possibly surgical planning. Although a number of insults to the genitourinary tract are not life threatening, recognizing the diagnostic imaging
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findings quickly is the realm of the perceptive radiologist so appropriate urologic or medical management can be made.
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