📋 Stepwise Management of GU Trauma
🔑 Key Principles — Nelson Ch 583
• Renal Trauma: Most common GU injury in children (blunt > penetrating). Indications for imaging: gross hematuria, microscopic hematuria with shock, deceleration mechanism. CT with delayed images is gold standard.
• Renal Injury Grading (AAST): Grade I (contusion), II (<1cm laceration), III (>1cm laceration), IV (collecting system injury/vascular contained), V (shattered kidney/hilar avulsion).
• Bladder Rupture: Suspect with pelvic fracture + gross hematuria. Retrograde cystogram (static). Intraperitoneal → surgical repair. Extraperitoneal → catheter drainage.
• Urethral Injury: Blood at meatus, inability to void, high-riding prostate. Retrograde urethrogram before catheterization.
• Testicular Rupture: Blunt trauma (sports). Ultrasound shows tunica disruption. Surgical exploration + debridement + closure.
⚠️ Key Warning: Do NOT pass a urethral catheter if blood at meatus, perineal hematoma, or high-riding prostate — perform retrograde urethrogram first to avoid converting partial tear to complete disruption.