Trauma

Renal injury

  • Classification I-V

Investigations

CT with contrast if:
  • Frank haematuria in adult
  • Frank or occult haematuria in a child
  • Occult haematuria and systolic <90 mmHg at any point
  • Penetrating injurt with any degree with contrast

Management

  • 98% of blunt renal injuries can be managed non-operatively - angiography/embolization
  • Surgery indications:
    • Persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma
    • Urinary extravasion, non-viable tissue, incomplete staging

Bladder injury

  • Commonly associated with pelvic fracture

Clinical presentation

  • Suprapubic/abdominal pain + inability to void
  • Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds

Investigations

  • Catheter - gross haematuria
    • If blood at external meatus or if cather doesn't pass easily then perform retrograde urethrogram - may have urethral injury
  • CT cystography
    • Extraperiteoneal injury - flame-shaped collection of contrast in pelvis

Management

  • Large-bore catheter
  • Antibiotics
  • Repeat cystogram in 14 days
  • Immediate surgical repair indicated in some cases e.g. intraperitoneal injury, penetrating injury

Urethral injury

  • Posterior urethral injury often associated with fracture of pubic rami
  • Post. urethra ficed at urogenital diaphragm and puboprostatic ligaments, so bulomembranous junction most vunerable

Clinical presentation

  • Blood at meatus
  • Inability to urinate
  • Palpably full bladder
  • 'High-riding' prostate
  • Butterfly perineal haematoma

Investigations

  • Retrograde urethrogram

Management

  • Suprapubic catheter
  • Delayed reconstruction after at least 3 months

Penile fracture

  • Typically happens during intercouse - buckling injury when penis slips out of vagina and strikes pubis

Clinical presentation

  • Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling
  • 20% evidence of urethral injury (frank haematuria/blood at meatus)

Management

  • Prompt exploration and repair
  • Circumcision incision with degloving of penis to expose all 3 compartments

Testicular injury

Clinical presentation

  • Usually presents with pain and nausea
  • Swelling/bruising variable

Investigations

  • USS to assess integrity/vascularity

Management

  • Early exploration/repair - better outcome