Hematuria in Patients Presenting After Trauma Blood in the urine after abdominal trauma suggests a urinary tract injury. Renal injuries are suggested by lower rib fractures. Bladder and urethral injuries are suggested by pelvic fractures. Foley Catheter The urethral meatus should be examined after trauma. Blood at the urethral meatus precludes insertion of a foley catheter into the bladder. Erroneously placing a foley in this situation can result in infections of periprostatic and perivesical hematomas or conversion of a partial transection to a complete urethral transections. Blood at the urethral meatus suggests an injury to the urethra. Otherwise a foley catheter can be placed into the bladder and hematuria can be assessed for. Abdominal Imaging Hemodynamically stable individuals should undergo further radiographic assessment. Abdominal computed tomography (CT) with contrast can detect retroperitoneal hematomas, renal lacerations, urinary extravasation, and renal arterial and venous injuries. A repeat scan ten minutes after the first is recommended. Retrograde Urethrography (RUG) The purpose of this study is to identify and characterize injuries to the urethra. The tip of a small (12F) foley catheter is placed in the urethral meatus. The catheter remains fixed after 3 mL of water are instilled into the foley catheter's balloon. Radiographic films are taken as 20 mL of water-soluble contrast material are injected This outlines the urethra from the urethral meatus to the bladder neck. If injuries exist, the location can be determined. Retrograde Cystography The purpose of this study is to identify bladder perforations. The bladder needs to be adequately distended with contrast medium. 300 mL or more are generally recommended. The study has two films. One film is taken when the bladder is adequately distended and filled with contrast. The next film is taken after the bladder is emptied without the assistance of a foley catheter. Angiography Helpful in identifying injuries to the kidney's parenchyma and vasculature.
Genitourinary tract injury
Urinary tract obstruction
Urogenital neoplasm
Urinary tract infection
Penile injury
Urethral foreign body
Urinary bladder disease
Abdominal trauma