GU trauma, because of its very often non life-threatening injuries and its subtle presentation, is very often overlooked and poorly recognized in the emergency departement. However, approximateley 10-20% of all injured patients have some kind of GU involvement which can lead to very debilitating long term sequalae such as incontinence and impotence.
Although the more life-threatening injuries of the primary survey must be addressed first, we must be alert to the clues pointing to the presence of GU injuries.
So in the OVERALL management of all trauma patients, it is very important that we have a complete understanding of GU injuries, how to deal with it and how it can impact on patient outcome.
Being good at managing trauma patients doesn’t only mean being good at putting chest tubes.
for purposes of investigation and staging of urologic injuries, GU traum is divided into…
Each category is futher subdivided on the basis of a blunt or penetrating mechanism of injury.
I’m going to focus on BLUNT trauma during my talk.
Female: severe pelvic fracture and bony displacement along with lacerations through the bladder neck and vagina are present in cases of urethral trauma.
Morbidity: 15% (stress) incontinence in this study by Andrich: Men from 19-51! In previous studies, depending on the method used to repair the urethra, the rate of Incontinence/impotence is up to 70%, needing RE-operation to correct the problem.
Journal of Urology, 1996 Oct.: Stricture:49-97%. Impotence:0-36%. Incontinence: 0-21%. (Impotence and incontinence is a complication of procedures with less strictures.
…and as you learned in your ATLS, Foley catheter is C.-I. if you suspect urethral trauma.