- 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 Morey AF, 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 their four institutions and performed focused literature review of retrospective series;
- of the 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
- 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