Emergency Management of Renal and Genitourinary Trauma: Best Practices Update

Publication Date: August 2017 (Volume 19, Number 8)

No CME for this activity

Authors

 

Whitney K. Bryant, MD, MPH, MEd

Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH

 

 

Director, Emergency and Critical Care Ultrasound, Department of Emergency Medicine, Coney Island Hospital, Brooklyn, NY

 

 

Abstract

 

In up to 10% of patients who experience abdominal trauma, renal and urogenital systems will be involved. In polytrauma patients with other potentially life-threatening injuries, renal and genitourinary trauma may be overlooked initially, but a delayed or missed diagnosis of these injuries may result in preventable complications. This review provides a best-practice approach to the diagnosis and management of renal and genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid long-term urinary sequelae such as hypertension, incontinence, erectile dysfunction, chronic kidney disease, and nephrectomy.

 

Excerpt From This Issue

 

You’ve just arrived for a long Saturday overnight when the EMS notification pager goes off. Your first patient is a 23-year-old man who was in an altercation outside a bar. He is intoxicated, has bruises and red marks that look like shoe prints all over his abdomen, flanks, and chest, and tells you it hurts “everywhere.” On his right flank, he has a 1- by 2-centimeter wound that he thinks was made by a screwdriver. You put out a trauma page, and in the interim, you wonder: will a urinalysis really help in working up this patient? What kind of special imaging is he going to need? Should I order pre-op labs?”

Into the next trauma bay arrives a 46-year-old woman, also intoxicated, who was the unrestrained and ejected passenger in a high-speed, rollover motor vehicle crash. She is hypotensive and tachycardic. She has a pelvic binder on, with a tense, swollen belly extending above it. During the resuscitation, you notice she is bleeding briskly from her vagina. Your nursing colleague asks if you want a Foley catheter. Should you place one? Do you need to page urology as well as trauma? Is it necessary to alert interventional radiology of this patient’s arrival?