Renal injury

• Classification I-V

Investigations

CT with contrast if:

• Frank haematuria in adult
• Frank or occult haematuria in a child
• Occult haematuria and systolic <90 mmHg at any point
• Penetrating injurt with any degree with contrast

Management

• 98% of blunt renal injuries can be managed non-operatively - angiography/embolization
• Surgery indications:
  • Persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma
  • Urinary extravasion, non-viable tissue, incomplete staging

Bladder injury

• Commonly associated with pelvic fracture

Clinical features

• Suprapubic/abdominal pain + inability to void
• Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds

Investigations

• Catheter: gross haematuria
  • If blood at external meatus or if cather doesn't pass easily then perform retrograde urethrogram - may have urethral injury
• CT cystography: extraperiteoneal injury (flame-shaped collection of contrast in pelvis)

Management