GU_Trauma - Genitourinary Trauma Franois Dufresne McGill...

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Unformatted text preview: Genitourinary Trauma Franois Dufresne McGill Emergency Medicine February 13 th 2002 The Case of Jeremy 23 y.o male Driver, Seatbelted Frontal Impact, High Speed ( 2245 100Km/h) Airbag + Other driver dead Car completely destroyed Empty EtOH bottles in the OTHER car Patient was conscious at the scene. On scene: BP=85/50 HR:120 RR:22 Sat:98% Jeremy A: Clear. C-spine protection. Backboard+ B: A/E symetric. O 2 Sat N. No crepitus. Trachea central. C: BP:100/60 HR:100 Mentating well. D: GCS=15 PERL. Pt is exposed. O 2- iv monitor Temperature N Capillary Glucose N Jeremy AMPLE C/O abdo. Pain + hip pain C/O right lower leg pain Secondary Survey Spleen normal. Mild suprapubic tenderness. Pelvic instability Probable right tibial # No gross blood at meatus. Rectal Normal. Doctor, can I put a Foley? Jeremy What are your concerns? Foley? What will be the usefulness of dipstick? Dipstick good enough? U/A? What if he has microscopic hematuria? What if he has a pelvic fracture? Any different if you had blood at meatus? Urethrogram? Cystogram? Abdominal CT? Worried about the kidneys? Bladder? Does the low BP changes your suspicion for a GU injury? Introduction GU Trauma overlooked 10-20% of all injured patients Long term morbidity Impotence Incontinence Life-threatening injuries first Plan Urethral Injury Bladder Injury Hematuria in Trauma Kidney Injury Definitions Upper tract Kidney Ureters Lower tract Bladder Urethra External genitalia Urethral Trauma Almost exclusively in male Significant morbidity Stricture Incontinence Impotence If unrecognized: Converting partial to complete tear Inaccurate assessment of U/O Foley catheter implication Andrich DE et al. The nature of urethral injury in cases of pelvic fracture urethral trauma . Journal of Urology. 165(5):1492-5, 2001 May. Anatomy Bladder Symphysis Prostatic Membranous Bulbous Pendulous Posterior Urethra Violent external force Pelvic # in 2245 90% Pelvic # : 5-25% of Posterior urethral injury Clinical Features Gross hematuria in 98% Inability to void Blood at urethral meatus Pelvic / suprapubic tenderness Penile / scrotal / perineal hematoma Boggy / high-riding prostate/ ill-defined mass on rectal examination. Digital Rectal Exam in Trauma Porter et al. Am Surg , 2001. Prospective Level II Trauma Center. 423 patients. DRE on all. 7 (1.7%) pelvic fracture. NO Urethral injury Prostate exam didnt change management Porter, J.M. et al. Digital rectal examination for trauma: does every patient need one? Am Surg 67(5):438, May 2001. Posterior Urethral rupture From McAnich JW. In Tanagho EA, McAninch JW, editors: Smiths general urology, ed 14, Norwalk, Conn, 1995, Appleton & Lange. Diagnosis:...
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GU_Trauma - Genitourinary Trauma Franois Dufresne McGill...

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