Genitourinary injuries are common with both blunt and penetrating trauma. Which of the following statement(s) is/are true concerning genitourinary trauma injuries?

c. CT scan is the current imaging technique of choice for suspected renal trauma

e. Extraperitoneal bladder ruptures can often be treated nonoperatively using urethral catheter drainage alone

Renal injuries constitute the greatest proportion of genitourinary tract trauma. The presence of hematuria remains the most sensitive clinical indicator of renal trauma. The specificity of hematuria is low, however, and the practice of performing an IVP in all patients with blunt trauma and microscopic hematuria is both time-consuming and unnecessary. In several studies examining clinical features associated with significant renal trauma, three factors have been identified—shock, gross hematuria, and major associated injuries. The incidence of renal trauma requiring operation in the absence of any of these factors was 0 in several series. The indications for radiographic assessment of renal injury in the face of penetrating trauma should be far more liberal, since there are conflicting reports on the degree of correlation between the injury’s severity and the degree of hematuria. Radiographic studies for the diagnosis of renal trauma include single-or multiple-film IVP, formal nephrotomography, and CT scan. Single-film (“one-shot”) IVP is useful primarily for documenting the presence of two functioning kidneys and has limited use as a screening examination for renal trauma. CT scan, however, has emerged as the imaging technique of choice for most renal trauma. Renal injuries can be staged with respect to those likely to require an operation or to develop complications. CT scan also allows more precise assessment of the degree of perinephric hemorrhage and the degree of collecting system disruption than operative inspection.

A number of major renal injuries are diagnosed at the time of laparotomy. Most commonly, a perinephric hematoma is encountered in association with blunt hepatic or splenic trauma. Indications for renal exploration at laparotomy following blunt trauma include an expanding or pulsatile perinephric hematoma or suspected renal vascular injury. In a patient with blunt injuries, it is preferable to defer exploration of nonexpanding, nonpulsatile perinephric hematomas to complete treatment of intraabdominal and other associated life-threatening injuries. Postoperative CT scan may be useful for formal staging of these injuries. A perinephric hematoma that is found during laparotomy for penetrating trauma should generally be explored carefully. Unlike blunt injuries, continued or recurrent hemorrhage is more often a problem.

Most bladder injuries (over 95%) occur in association with pelvic fractures. Bladder ruptures are classified into those that rupture into the free peritoneal cavity and those with extravasation limited to the retroperitoneum. Intraperitoneal bladder ruptures are characteristically large and require early operative repair. Extraperitoneal bladder ruptures in most cases, however, can be treated nonoperatively using simple urethral catheter drainage alone.