Four important injuries. Four different imaging studies to obtain.

Step 1: Obtain Pelvic X-Ray

* Commonly performed at bedside as part of initial trauma evaluation* A pelvic injury significantly increases risk of GU injury

Step 2: Examine the Perineum

* Common signs of GU injury* Blood at urethral meatus* Bruising of the perineum

Step 3: Obtain Urinalysis

* Gross hematuria is the red flag* Can be identified at bedside* Importance of microscopic hematuria uncertain* If you decided to send a formal urinalysis…* Patient needs follow up on the hematuria until resolved

Step 4: Consider the FOUR Genitourinary Injuries

* Kidney injury* Evaluate with CT scan abdomen/pelvis with IV contrast* Occur in approximately 10% abdominal trauma* Flank pain* Lower rib trauma* Ureteral injury* Evaluate with delayed CT scan abdomen/pelvis with IV contrast* Call radiology to help choose right imaging protocol* RARE injury* Sometimes seen with penetrating trauma or surgical injury* Frequently needs surgical repair* Bladder injury* Evaluate with retrograde cystogram* Occurs when patient with distended bladder has direct impact to low abdomen* Urethral injury* Evaluate with retrograde urethrogram (RUG)* TWO subtypes* Posterior injury* Occur with pelvic fractures* Anterior injury* Occur with straddle-type injuries

Additional Reading

* The Importance of the RUG (Taming the SRU)* Genitourinary Trauma (emDOCs)