Advertisement
Research Article| Volume 22, ISSUE 6, P471-474, November 1991

Urinary tract injuries in multiply-injured patients: a rational guideline for the initial assessment

DOI:https://doi.org/10.1016/0020-1383(91)90132-X
Urinary tract injuries in multiply-injured patients: a rational guideline for the initial assessment
Previous ArticleHigh-pressure injection injuries
Next ArticleDelayed diagnosis of injuries from the M1 aircraft accident
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      In a retrospective study involving 866 multiply-injured patients we demonstrated urinary tract injuries in 72 patients (8.3 per cent), 17 (2 per cent) of which were serious. Haematuria was a frequent finding in multiply-injured patients. In patients with serious lesions of the urinary tract, more than 35 RBCs/HPF in the sediment or macroscopic haematuria were found. All major injuries were demonstrated by the emergency intravenous urogram. Ultrasonography demonstrated contusions of the kidney or bladder and ruptures of the kidneys, but was not reliable in diagnosing ruptures of the bladder.
      Of 155 patients with a pelvic fracture 13 (8 per cent) had lower urinary tract injuries. In all these patients the fracture was located in the pubic arch. If a retrograde urethrogram was performed in these patients all urethral lesions were detected.
      We propose a rational guideline, which guarantees diagnostic accuracy of serious injuries of the urinary tract after blunt trauma, while interfering as little as possible with the resuscitative and diagnostic procedures in severely injured patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Antoci J.P.
        • Schiff Jr., M.
        Bladder and urethral injuries in patients with pelvic fractures.
        J. Uron. 1982; 128: 25
        • Belis J.A.
        • Recht K.A.
        • Milam D.F.
        Simultaneous traumatic bladder perforation and disruption of the prostato-membranous urethra.
        J. Urol. 1979; 122: 412
        • Bright T.C.
        • White K.
        • Peters P.C.
        Significance of hematuria after trauma.
        J. Urol. 1978; 120: 455
        • Caille J.M.
        • Guibert F.
        • Bidbe A.M.
        • et al.
        Enhancement of cerebral infarcts with CT.
        Comput. Tomogr. 1980; 4: 73
        • Cass A.S.
        Bladder trauma in the multiple injured patient.
        J. Urol. 1976; 115: 667
        • Cass A.S.
        • Luxenberg M.
        • Gleich P.
        • et al.
        Clinical indications for radiographic evaluation of blunt renal trauma.
        J. Urol. 1986; 136: 370
        • Chandhoke P.S.
        • McAninch J.W.
        Detection and significance of microscopic hematuria in patients with blunt renal trauma.
        J. Urol. 1988; 140: 16
        • Chester J.K.
        • Rosenfield A.T.
        • Armm M.
        Gray-scale ultrasonography in the evaluation of renal trauma.
        Radiology. 1980; 134: 461
      9. Enge I. Edgren J. Patient Safety and Adverse Events in Contrast Medium Examinations. Elsevier Science Publishers BV (Biomedical Division), Amsterdam1989: 25
        • Fallon B.
        • Wendt J.C.
        • Hawtrey C.E.
        Urological injury and assessment in patients with fractured pelvis.
        J. Urol. 1984; 131: 712
        • Filiatrault D.
        • Longpre D.
        • Patriquin H.
        • et al.
        Investigation of childhood blunt abdominal trauma: a practical approach using ultrasound as the initial diagnostic modality.
        Pediatr. Radiol. 1987; 17: 373
        • Flaherty J.J.
        • Kelly R.
        • Burnett B.
        • et al.
        Relationship of pelvic bone fracture patterns to injuries of urethra and bladder.
        J. Urol. 1968; 99: 297
        • Fortune J.B.
        • Brahme J.
        • Mulligan M.
        • et al.
        Emergency intravenous pyelography in the trauma patient.
        Arch. Surg. 1985; 120: 1056
        • Freni S.C.
        • Heederik G.J.
        • Hol C.
        Centrifugation techniques and reagent strips in the assessment of micro-haematuria.
        J. Clin. Path. 1977; 30: 336
        • Froom P.
        • Ribak J.
        • Benbassat J.
        Significance of microhaematuria in young adults.
        Br. Med. J. 1984; 288: 20
        • Griffen W.O.
        • Berlin R.P.
        • Ernst C.B.
        • et al.
        Intravenous pyelography in abdominal trauma.
        J. Trauma. 1978; 18: 387
        • Guice K.
        • Oldham K.
        • Eide B.
        • et al.
        Haematuria after blunt trauma: When is pyelography useful?.
        J. Trauma. 1983; 23: 305
        • Hardeman S.W.
        • Husmann D.A.
        • Chinn H.K.W.
        • et al.
        Blunt urinary tract trauma: identifying those patients who require radiological studies.
        J. Urol. 1987; 138: 99
        • Kisa E.
        • Schenk III, W.G.
        Indications for emergency intravenous pyelography (IVP) in blunt abdominal trauma: a reappraisal.
        J. Trauma. 1986; 26: 1086
        • Levitt M.A.
        • Criss E.
        • Kobernick M.
        Should the emergency IVP be used more selectively in renal trauma?.
        Ann. Emerg. Med. 1985; 14: 959
        • Lowe M.A.
        • Mason J.T.
        • Luna G.K.
        • et al.
        Risk factors for urethral injuries in men with traumatic pelvic fractures.
        J. Urol. 1988; 140: 506
        • Monstrey S.J.M.
        • Vander Werken Chr.
        • Debruyne F.M.J.
        • et al.
        Rational guidelines in renal trauma assessment.
        Urology. 1988; 31: 469
        • Nicolaisen G.S.
        • McAninch J.W.
        • Marshall G.A.
        • et al.
        Renal trauma: re-evaluation of the indications for radiographic assessment.
        J. Urol. 1985; 133: 183
        • Oackland C.D.H.
        • Britton J.M.
        • Charlton C.A.C.
        Renal trauma and the intravenous urogram.
        J. R. Soc. Med. 1987; 80: 21
        • Peiper H.-J.
        • Schmid A.
        • Steffens H.
        • et al.
        Ultraschalldiagnostik beim akuten abdomen und stumpfen bauchtrauma.
        Chirurg. 1987; 58: 189
        • Pokorny M.
        • Pontes J.E.
        • Pierce Jr., J.M.
        Urological injuries associated with pelvic trauma.
        J. Urol. 1979; 121: 455
        • Uehara D.T.
        • Eisner R.F.
        Indications for intravenous pyelography in trauma.
        Ann. Emerg. Med. 1986; 15: 266
        • Wong L.
        • Waxman K.
        • Smolin M.
        • et al.
        The role of IVP in blunt trauma.
        J. Trauma. 1988; 28: 502

      Article info

      Publication history

      Accepted: March 7, 1991

      Identification

      DOI: https://doi.org/10.1016/0020-1383(91)90132-X

      Copyright

      © 1991 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX