Genitourinary trauma covers injury to the kidneys, ureters, bladder, urethra and external genitals, most often from blunt trauma such as car crashes and falls. It often comes with other injuries, so it is assessed as part of the full trauma survey.
Key symptoms
- Blood in the urine, visible or on testing
- Flank, abdominal or pelvic pain
- Trouble urinating or unable to urinate
- Pain, swelling or bruising of the genitals or perineum
What you find on exam
- Primary survey (ABCDE) and look for shock
- Flank bruising or rib fractures
- Blood at the urethral meatus, perineal or scrotal bruising
- Unstable pelvis
Tests
- Urinalysis for blood
- CT abdomen and pelvis with contrast and delayed images of the urinary tract
- Retrograde urethrogram before a catheter if urethral injury is suspected
- CT or retrograde cystogram for bladder injury
- Scrotal ultrasound for testicular injury
Treatment basics
- Treat life threats first; pelvic binder for an unstable pelvis
- Most kidney injuries are managed without surgery if the patient is stable
- No urethral catheter if there is blood at the meatus; suprapubic catheter if needed
- Surgical repair for intraperitoneal bladder rupture or testicular rupture
Red flags
- Blood at the urethral meatus
- Unstable vital signs with a flank or pelvic injury
- Unable to urinate after pelvic trauma
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.