Genitourinary Trauma for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Genitourinary Trauma for Certified Emergency Nursing (CEN)
Outline
Genitourinary Trauma
Definition/Etiology:
- 65% blunt trauma vs 35% penetrating trauma
- Most common in males <30 years old
- Frequently not lethal, but commonly assoc w pelvic fracture or similar which can be lethal
- Genitourinary trauma includes bladder, urethra, and external genitalia of both males and females.
- Frequent mechanisms can include motorcycle crash, GSWs, sexual trauma and bicycles. Can also occur with harness injury (rock climbers, skydivers, linemen, etc).
- If a bladder injury communicates with the peritoneum, it requires surgical repair.
Pathophysiology:
Possible undesirable sequelae:
- urinary incontinence
- difficulty voiding
- sexual dysfunction
- secondary psychosocial stressors
- fistula formation
Possible mechanisms:
- Motor vehicle crash
- Motorcycle crash
- Fall from height
- Straddle injury (mountain biking, etc)
- Sexual assault
- Consensual intercourse
Possible injuries:
- Laceration of external genitalia
- Abrasions
- Penile fracture
- Testicular torsion (twisting)
- Testicular displacement (out of scrotum, usually into peritoneum)
- Testicular rupture
- Bladder rupture (most likely if bladder is full when injured)
- Urethral injury (more common in males since urethra is longer)
- Concomitant rectal or vaginal injury
Clinical Presentation:
- suprapubic tenderness
- hematuria
- blood at the urethral meatus (if present, do not catheterize)
- difficulty voiding
- ecchymosis
- hematoma
- possible unstable pelvis (mortality from internal bleeding)
- Pain
- Patient may be hyperfocused on this injury in spite of other injuries also present
- Immediate loss of erection if penile fracture. Also, hematoma, rapid swelling, ecchymosis. Patient often reports hearing/feeling a pop.
Collaborative Management:
- Evaluate for possible upper GU trauma also (kidneys, ureters). Kidney injury can be fatal.
- Utilize SANE (sexual assault nurse examiner) if appropriate
- If suspected assault, and SANE is available, let them handle all undressing of patient to get in a gown so that evidence is preserved.
- Social worker if appropriate
- Urethral catheterization or suprapubic is usually performed by urology
Testing:
- Urinalysis
- CT abdomen/pelvis
- Ultrasound
- Pyelogram/Cystogram/Urethrogram
- KUB radiograph
Evaluation | Patient Monitoring | Education:
- Frequent monitoring of vitals
- Pain management with medication, ice packs
- Full trauma assessment
- Be aware of possible sexual assault
- Emotional support
- Social worker consult
Linchpins (Key Points)
- Genitourinary tract is seldom injured in isolation.
- Look for other life-threatening injuries. Don’t just focus on distracting one.
- Kidney injury and/or pelvic fracture can be lethal.
- Keep in mind possible sexual assault for all patients, not just women.
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Runyon, M. S. (2021, April 5). Blunt genitourinary trauma: Initial evaluation and management. UpToDate. https://www.uptodate.com/contents/blunt-genitourinary-trauma-initial-evaluation-and-management
- Runyon, M. S. (2022, February 15). Penetrating trauma of the upper and lower genitourinary tract: Initial evaluation and management. UpToDate. https://www.uptodate.com/contents/penetrating-trauma-of-the-upper-and-lower-genitourinary-tract-initial-evaluation-and-management
- Voelzke, B. (2021, August 11). Overview of traumatic lower genitourinary tract injury. UpToDate. https://www.uptodate.com/contents/overview-of-traumatic-lower-genitourinary-tract-injury
- Voelzke, B. (2021, January 14). Overview of traumatic upper genitourinary tract injury. UpToDate. https://www.uptodate.com/contents/overview-of-traumatic-upper-genitourinary-tract-injuries-in-adults
NCLEX
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