- See:
-
Bleeding from Pelvic Frx:
-
Urogenital Trauma from Pelvic Frx:
-
Diff Dx of Hematuria:
- Discussion:
- pts w/ high probability for genito-urinary trauma include those w/ gross hematuria (or microscopic) associated w/ shock;
- most severe injuries tend to occur w/ gross hematuria;
- w/ concomitant pelvic fracture,
bladder rupture is a common occurance;
- microscopic hematuria w/o shock following trauma may be observed w/ repeated urinanalysis;
- more often, microscopic hematuria is a consequence of contussion, and will resolve spontaneously w/o treatment;
- renal imaging is required in all pts w/ microscopic ( > 5 pRBC/HPF) or gross hematuria sustaining
penetrating trauma or in pediatric pts;
- most common contrast x-ray is urography, which is indicated in pts w/ pelvic frxs & if gross
or microscopic hematuria is present;
- if microscopic hematuria is minor (< 10 RBC/HPF), repeat urinalysis may be indicated befored determining need for contrast urography;
- in the report by AF Morey et al 2001, the authors sought to establish guidelines for diagnostic imaging for
bladder rupture in the blunt trauma victim with multiple injuries;
- the authors evaluated a chart review (1995-1999) of patients with blunt trauma and bladder rupture at our
four institutions and performed focused literature review of retrospective series;
- of our 53 patients identified, all had gross hematuria and 85% had pelvic fracture;
- the classic combination of pelvic fracture and gross hematuria constitutes an absolute
indication for immediate cystography in blunt trauma victims;
- existing data do not support lower urinary tract imaging in all patients with either
pelvic fracture or hematuria alone;
- Bladder Rupture after Blunt Trauma: Guidelines for Diagnostic Imaging
AF. Morey, MD.
Journal of Trauma 2001;51:683-686
- HTN is uncommon after renal injury, ocurring less than 5% of pts;
- when HTN does develop, it is caused by patial ischemia to a renal segment, which activates the renin angiotensis system;
