Urinary tract injuries

Rationale

Urinary tract injuries are usually caused by blunt trauma rather than penetrating trauma. The injuries may affect the kidneys and/or the collecting system and may lead to life-threatening bleeding.

Causal Conditions

(list not exhaustive)

1. Renal trauma (e.g., blunt trauma)
2. Bladder and urethral trauma
   1. Distal urethra (e.g., straddle injuries from bicycle crossbar)
   2. Proximal urethra/bladder (e.g., pelvic fracture, abdominal injury)

Key Objectives

Given a patient with a urinary tract injury, the candidate will diagnose the cause, severity and complications, and initiate an appropriate management plan. In particular, the candidate will consider trauma to the bladder or posterior urethra in patients with a pelvic fracture.

Enabling Objectives

Given a patient with a possible urinary tract injury, the candidate will

1. list and interpret the critical clinical findings, including those based on
   1. data from history regarding the mechanism of the injury and symptoms (e.g., abdominal pain, difficulty voiding, hematuria, blood at meatus),
   2. physical examination (e.g., perineal swelling and/or bruising), and
   3. digital rectal examination (e.g., prostate gland injury);
2. list critical investigations and interpret the results of the investigations, including appropriate imaging if required (e.g., retrograde urethrography for urethral injury, cystography for bladder injury, computed tomography for renal injury);
3. construct an effective initial management plan, including
   1. resuscitating the injured patient and assessing their response to resuscitation,
   2. avoiding repeated attempts at bladder catheterization when unsuccessful,
   3. initiating management of anterior urethral injury, and
   4. referring the patient for specialized care if necessary.