Pelvic/Genitourinary Trauma

[Pelvic Fx Main] [Pelvic Fx anatomy]


Etiology

Clinical Pearl
Gross hematuria suggests bladder injury.

History

Physical Examination

Clinical Pearl
In the case of gross hematuria, the GU system is investigated from distal to proximal (i.e. urethrogram, cystogram, etc.)

Investigations

Management


Contraindications to Foley Catheterization:

PELVIC TRAUMA

Hematoma

Fracture
Fracture
+
Bleeding
(-)Expanding
(+)Expanding
R/O:
- Urethral injury in Men (Retrograde Urethrogram)
- Bladder Injury (Retrograde Cystogram)
- Rectal injury
- Vaginal injury

FAST (US)

(+) BLEED
(-) BLEED

Do NOTHING

Arteriographic Embolectomy

vs

External Fixation

Arteriographic Embolectomy

vs

External Fixation

DO NOTHING

GENITOURINARY TRAUMA

PENETRATING
BLUNT
SURGERY Pelvic Fracture Scrotal
Hematoma
Rib
Fracture
Uretheral Bladder Testical Below Nipple
Anterior
Posterior

- Pain radiating to shoulder

     ↓

Retrograde Cystogram
  +
Post-void films

    ↓

SURGERY

Swollen
Normal

R/O:
- Kidney injury (CT-Scan)

SURG.

- Pt wants to void but Can't
- HIGH ridding prostate
     ↓
1. NO FOLEY
     ↓
2. Retrograde
Urethrogram
3. Suprapubic Drain & Delay Surgery
 

1. US
(+)
Rupture:
SURGERY

(-) Rupture:
NOTHING

NOTHING