Genitourinary Trauma

1. See Also
   1. Secondary Survey
2. Exam
   1. Pelvic stability
   2. Perineum exam
   3. Vaginal and pelvic exam in women
   4. Scrotal exam in men
   5. Evaluate for bood at Urethral meatus
3. Associated Conditions
   1. Pelvic Fracture
   2. Urethral Injury
   3. Vaginal Injury
   4. Bladder rupture
4. Precautions
   1. Do not insert Foley Catheter if Urethral blood, scrotal hematoma or high riding Prostate
   2. As with Abdominal Trauma, avoid unnecessary studies that delay exploratory laparoscopy when it is clearly indicated
5. Imaging
   1. Most studies have been replaced by CT Abdomen and Pelvis
   2. CT Abdomen and Pelvis
      1. First-line preferred study
      2. Indicated for Pelvic Fracture evaluation as well as free peritoneal fluid and retroperitoneal fluid evaluation
      3. Perform with IV Contrast (administer with oral contrast and possibly rectal contrast if time allows)
   3. XRay Pelvis
      1. Evaluate for Pelvic Fracture
   4. Intravenous pyelogram
      1. CT Abdomen and Pelvis is preferred
      2. Demonstrates Renal Function as well as dye extravasation in cases of urinary tract disruption
      3. Indications
         1. Hematuria
         2. Flank injury or mass
         3. Absent psoas shadow
         4. Lower bony thorax injury
   5. Retrograde cystourethrogram Indications
      1. Perineal or scrotal hematoma
      2. Blood at uretheal meatus
      3. High riding Prostate
      4. Pelvic Fracture or pubic symphysis diastasis suspected
      5. Inability to void