Four important injuries. Four different imaging studies to obtain.

Step 1: Obtain Pelvic X-Ray

  • Commonly performed at bedside as part of initial trauma evaluation
  • A pelvic injury significantly increases risk of GU injury

Step 2: Examine the Perineum

  • Common signs of GU injury
    • Blood at urethral meatus
    • Bruising of the perineum

Step 3: Obtain Urinalysis

  • Gross hematuria is the red flag
    • Can be identified at bedside
  • Importance of microscopic hematuria uncertain
    • If you decided to send a formal urinalysis…
    • Patient needs follow up on the hematuria until resolved

Step 4: Consider the FOUR Genitourinary Injuries

  • Kidney injury
    • Evaluate with CT scan abdomen/pelvis with IV contrast
    • Occur in approximately 10% abdominal trauma
      • Flank pain
      • Lower rib trauma
  • Ureteral injury
    • Evaluate with delayed CT scan abdomen/pelvis with IV contrast
      • Call radiology to help choose right imaging protocol
    • RARE injury
      • Sometimes seen with penetrating trauma or surgical injury
    • Frequently needs surgical repair
  • Bladder injury
    • Evaluate with retrograde cystogram
    • Occurs when patient with distended bladder has direct impact to low abdomen
  • Urethral injury
    • Evaluate with retrograde urethrogram (RUG)
    • TWO subtypes
      • Posterior injury
        • Occur with pelvic fractures
      • Anterior injury
        • Occur with straddle-type injuries

Additional Reading