Urologic injury often occurs in the context of severe multisystem trauma that requires close cooperation with trauma surgeons. Approximately 10 percent of patients suffering injuries severe enough to require admission to a trauma service sustain injury to the genitourinary tract. Adrenal trauma incidence and significance trauma to the adrenal glands is unusual because of their relatively wellprotected position deep in the retroperitoneum, so injury to these organs occurs in the setting of mas. They usually result from gunshot wounds and rarely from stab wounds. The incidence of penetrating trauma is also increasing, which is seen particularly in inner city trauma centers, and is becoming a major cause of renal injury 3, 4. Approximately 10% of trauma patients sustain injury to the genitourinary system.
Genitourinary injuries occur in 1020% of major trauma patients. Genitourinary trauma knowledge for medical students and. Injuries to the abdomen that go unrecognized or untreated are a leading cause of traumatic death. Penile trauma is less common than scrotaltesticular trauma, but still comprises 1016% of genitourinary injuries per several single institution series.
Jan 23, 2017 because trauma is a multisystem disease, multiple injuries may be present in the trauma patient. The close cooperation between radiologists and urologists is essential for the most effective management of genitourinary trauma. The anterior urethra includes the bulbous and pendulous portion. Emergency management of renal and genitourinary trauma. For trauma patients in the ed, life and limbthreatening injuries take priority, but renal and genitourinary injury can have longterm consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems. In many cases, laparotomy may be needed to assess for other abdominal and pelvic injuries. Protected because of the symphysis pubis and its shorter length retrograde urethrography is not recommended in the er. Injury to the genitourinary tract is a common occurrence after both blunt and penetrating trauma. Delayed recognition of these injuries may have the unique complication of urinary extravasation. Most of these injuries, with the exception of renal hilar disruption or shattered kidney, are not immediately life threatening. Because trauma is a multisystem disease, multiple injuries may be present in the trauma patient. A european registry of road traffic crash victims compiled between 1996 and 2001 recorded trauma to the genitourinary system in 0.
This article describes the care of the patient with genitourinary trauma focusing on assessments, diagnostic testing, and patient care. In children, avulsion injuries are more common and occur at the ureteropelvic junction. Small size, mobility, protected location 1% of all urinary tract trauma. Damage to the kidney represents the most common type of urinary tract injury. Pdf on jan 1, 2018, liaqat ali and others published genitourinary trauma find, read and cite all the research you need on.
Gu trauma is broadly divided into blunt and penetrative and based on the. Injuries to the lower genitourinary gu tract alone are not life threatening, but their association with other potentially more significant injuries necessitates an organized approach to diagnosis and management. Other injuries often take priority over injuries to the genitourinary gu system and may initially interfere or postpone a complete urologic assessment. To avoid the subsequent morbidity, a high index of suspicion must be maintained, and the appropriate radiographic evaluation performed. Mohamed shafikurology department alexandria university 2.
The posterior urethra includes the prostatic and membranous urethra. The diagnosis of genitourinary trauma typically relies on patient history, physical examination, urinalysis, and imaging ct, cystoscopy, retrograde urethrogram. The two broad anatomical separations are the posterior and anterior urethra. Other injuries often take priority over injuries to the gu system and may initially interfere or postpone a complete urologic assessment. Timely identification and management of genitourinary injuries can minimize the associated morbidity, which may include impairment of urinary continence and sexual function. Blunt injuries to the bladder typically result from a blow to the lower abdomen when the bladder is distended or when the pelvis is fractured.
Genitourinary gu organs are commonly injured in trauma patients. Chapter 35 abdominal and genitourinary trauma flashcards. Chapter 36 abdominal and genitourinary trauma flashcards. In this article, we discuss the role of imaging in the management of patients with genitourinary trauma.
Discuss the evaluation and treatment of a patient1234 5 with genitourinary trauma. Evaluation and management of patients who have traumatic injuries to the genitourinary tract have undergone. Hollow organ injuries stomach usually injured due to blunt trauma full stomach prior to incident risk of injury spillage of contents into peritoneal cavity immediate pain, tenderness, guarding, and rigidity small and large intestines usually injured due to penetrating trauma spillage of contents into. Genitourinary trauma in the modern era of warfare journal. Fortunately, the incidence of lower urinary tract injury in children is quite low, estimated at 0. Emergency management of renal and genitourinary trauma eb. Jan 24, 2017 because trauma is a multisystem disease, multiple injuries may be present in the trauma patient. We provide both acute care in the trauma setting as well as a wide range of reconstructive options for patients who have suffered complex injuries to the. In particular, pelvic fractures may be the source of major hemorrhage.
The genitourinary system may be exposed to a variety of possible injuries from the time the fetus develops. Concomitant genitourinary gu injury, especially to the kidney, occurs in up to 40% of patients with abdominal trauma. Abdominal and genitourinary trauma authorstream presentation. In one large civilian study, penetrating penile trauma accounted for 33% of all penetrating genital trauma scrotum48%. When compared to our abdominal trauma patients without gu injuries, those with gu trauma had a higher severity of injury iss 2111 vs 1610 and higher mortality rates 26% vs 16%, p genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid longterm urinary sequelae such as hypertension, incontinence, erectile dysfunction, chronic kidney disease, and nephrectomy. Individuals may suffer from congenital disorders, cancer, trauma, infection, inflammation, iatrogenic injuries, or other conditions that may lead to genitourinary organ damage or loss and necessitate eventual reconstruction. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Genitourinary system an overview sciencedirect topics.
Genitourinary trauma is a common finding in the patient with multitrauma, and includes injuries to the kidneys, bladder, ureters, urethra, penis, and scrotum. See initial management of trauma in adults and initial evaluation and management of blunt abdominal trauma in adults and pelvic trauma. During the global war on terror, rates of genitourinary injuries have increased by nearly 350%. Noniatrogenic ureteral injuries account for only about 1 to 3% of all genitourinary trauma. The incidence of urological tract injury following. Similarly, trauma to the genitourinary system is often overlooked, despite 10% of all trauma patients having some form of genitourinary injury. Current practices, as well as old and more recent controversies involving diagnostic and therapeutic approaches, are discussed. In these cases, additional imaging studies to assess for genitourinary injury occur later, outside of the emergency department. Lower genitourinary tract trauma david bayne, uwais zaid, amjad. Ct with iv contrast is the gold standard in assessing renal and gu trauma more sensitive and specific than ivp, ultrasound, or angiography however, can miss significant injuries to the renal pelvis, collecting system and ureter given ct generally obtained before contrast is excreted in the urine. Genitourinary trauma an overview sciencedirect topics. Because they are often accompanied by potentially lifethreatening injuries to other organ systems, it is easy for the emergency physician to overlook.
Genitourinary trauma involves injury to the kidneys, ureters, bladder, andor urethra. Start studying chapter 35 abdominal and genitourinary trauma. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Management relies upon manual replacement and secondary orchidopexy. Genitourinary trauma and reconstruction program penn medicine. Pdf on jun 1, 2012, timothy c hardcastle and others published chapter 263. Abdominal and genitourinary trauma vicki bacidore abdominal injuries are a significant source of morbidity and mortality, ranking third as a cause oftraumatic death, preceded only by injuries to the head and chest. Management of genitourinary trauma smith 1968 aorn. Genitourinary injury occurs in 25% of all trauma patients and in at least 10% of patients with abdominal trauma, emphasizing the need for a close collaboration between the. List the different types of genitourinary trauma 1234 5 and their possible causes. Identification of these injuries is essential as they can be overlooked in the setting of multitrauma. Cureus impact of genitourinary injuries on patients.
Alright, now in this part of the article, you will be able to access the free pdf download of rosens emergency medicine 8th edition pdf using our direct links mentioned at the end of this article. In up to 10% of patients who experience abdominal trauma, renal and urogenital systems will be involved. Typically caused by trauma from surgery or during delivery, a genitourinary fistula tract will cause urine to be directed away from its normal location in the ureters tubes that bring urine from the kidney to the bladder, bladder or urethra. Genitourinary trauma has become increasingly commonplace in the modern era of warfare. Genitourinary trauma and reconstruction team this list represents the breadth of penn medicine providers who specialize in the treatment and management of genitourinary trauma, often working together as a team to provide the highest level of patient care. It may result in high morbidity if not properly identified and managed.
Renal injury is common, occurring in 810% of cases of blunt and penetrating trauma. Management depends on what part of the urethra was injured and to what extent. Renal injuriesrenal injuries ureteral injuries bladder injury urethral injuries 3. Genitourinary trauma penns level 1 trauma center provides comprehensive care for trauma injuries to any genitourinary organ, including complex injuries of the kidneys, bladder, and urethra. The majority of these injuries approximately 80% are the result of a blunt trauma mechanism. Genitourinary trauma, management of practice management. Genitourinary trauma, diagnostic evaluation of practice. Genitourinary trauma and reconstruction team penn medicine.
The rise in genitourinary battlefield injuries can be largely attributed to changing mechanisms of modern combat and the proliferation of improvised explosive. The close cooperation between radiologists and urologists is essential for the most. Identification of these injuries is essential as they can be overlooked in the setting of multi trauma. In polytrauma patients with other potentially lifethreatening injuries, renal and genitourinary trauma may be overlooked initially, but a delayed or missed diagnosis of these injuries may result in preventablecomplications. Crack cast show notes genitourinary trauma october 2016. Genitourinary trauma trauma, 8e accesssurgery mcgraw. Urotrauma guideline american urological association. Start studying chapter 36 abdominal and genitourinary trauma. Penetrating genitourinary trauma has a more straightforward imaging approach than blunt trauma.
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