Emergency Management of Urologic Trauma

Urologic emergencies

Genitourinary emergencies are commonly seen in the emergency room, and the primary care physician plays a vital role in the initial evaluation and treatment of each. Although genitourinary trauma is rarely life threatening, it may be the cause of significant long-term morbidity. Key clinical indicators outlined in this article (eg, inability to urinate, gross hematuria) combined with judicious use of imaging help stage the injury and allow a safe and rational approach to treatment. The acute scrotum frequently presents a challenging problem to both the emergentologist and urologist. Although epididymitis may be managed nonoperatively, there should be no delay in exploring suspected testis torsion. The conditions of the penis outlined require urgent treatment to preserve potency (priapism) and restore normal function (eg, penile amputation). Acute urinary retention has a myriad of underlying etiologies, and treatment must be individualized. Urgent bladder decompression by urethral or suprapubic catheterization provides initial relief until urologic consultation is available.

Experience with lower urinary tract disruptions associated with pelvic fractures: implications for emergency room management

A retrospective review of prospectively gathered data from 249 trauma patients was undertaken to study the association of lower urinary tract disruptions with pelvic fractures and to confirm guidelines for the initial investigation and management of such patients in the emergency room. Of 249 patients with pelvic fractures, 124 (50%) had haematuria and 17 (7%) had lower urinary tract disruptions (7 urethral ruptures, 9 bladder ruptures and 1 patient with both bladder and urethral ruptures). Gross haematuria or blood at the urethral meatus was noted in 16 of 17 patients with urological injuries. Twenty-five per cent of patients with unstable pelvic fractures had lower urinary tract disruption compared to 6% of patients with stable fractures (P < 0.05). Retrograde urethrography followed by cystography is indicated in all cases of pelvic fractures with blood at the urethral meatus, macroscopic haematuria or associated signs such as inability to void and perineal haematoma. Urinary diversion alone was used in partial urethral ruptures while surgical exploration and repair were performed in complete urethral ruptures and in most cases of bladder ruptures.