He is a proponent of CT for evaluation and staging of all GU injuries to kidneys, ureters and bladder.
Only 2.6% of blunt renal injuries and 57% of penetrating injuries require exploration.
Indications for Renal exploration:
expanding or pulsatile hematoma
Relative indications: urine extravasation, non-viable tissue.
During exploration: debride all non-viable tissue and provide water-tight closure. Gelfoam is a good hemostatic agent to use.
83% of explored kidneys are salvaged.
Ureters: all should be stented and drained.
His algorithm for Pelvic Fracture (15% have associated bladder or ureteral injury)
No blood at meatus -> pass foley. Only do RUG if blood at meatus or foley won't pass.
Once foley is in - if hematuria -> cystogram. No hematuria -> observe.
Cystogram can be Plain films (full & empty) or CT cystogram.
All Intra-peritoneal bladder injuries should be repaired.
Extra-peritoneal bladder injuries should be repaired if the abdomen is being explored.
15-20% of blunt urethral injuries have associated bladder injuries.
Suprapubic Cystostomy can be used to temporize for delayed urethral repair.
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