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Emergency Management of Renal and Genitourinary Trauma: Best Practices Update (Trauma CME)

August 2017

Inside This Issue

For trauma patients in the ED, life- and limb-threatening injuries take priority, but renal and genitourinary injury can have long-term consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems. This issue offers a review of the literature regarding treatment of renal and GU injuries, from diagnosis to management to disposition.

  • The mechanism of the trauma can be a clue to the injury sustained:
    • Rapid deceleration forces can injure the kidney, from contusions to shattering
    • Most injuries to the ureter are a result of penetrating trauma
    • Bladder injuries are often seen in pelvic fractures
    • Injuries to the external genitalia are more likely from sports or sexual intercourse
  • Gross hematuria is the best indicator of injury, but its absence does not rule out injury; in penetrating trauma, there is no correlation between the amount or even presence of hematuria and the degree of injury.
  • The type of injury suspected will dictate the diagnostic studies needed: CT, CT cystography, intravenous pyelogram, retrograde urethrogram, or ultrasound.
  • With grade IV or V kidney injuries, 10-minute-delayed IV contrast CT scans should be obtained.
  • Do not place a urinary catheter if there is a possibility of urethral injury.
  • In the last 20-30 years, conservative management therapies have become standard. 

Key words: genitourinary, GU, renal, kidney, ureter, bladder, urethra, scrotum, testicle, penis, perineum, saddle injury, pelvic fracture, blunt, penetrating, hematoma, contusion, laceration, rupture, eggplant, aubergine, hematuria, intravenous pyelogram, cystogram, extravasation, catheter, Foley, suprapubic, nephrectomy

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Last Modified: 12/12/2017
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