Urotrauma

Clinicians should perform diagnostic imaging with intravenous contrast enhanced computerized tomography in stable blunt trauma patients with gross hematuria or microscopic hematuria and systolic blood pressure <90 mmHg. (Strong, B)

Clinicians should perform diagnostic imaging with IV contrast enhanced CT in stable trauma patients with mechanism of injury or physical exam findings concerning for renal injury (e.g., rapid deceleration, significant blow to flank, rib fracture, significant flank ecchymosis, penetrating injury of abdomen, flank, or lower chest). (Moderate, C)

Clinicians should perform IV contrast enhanced abdominal/pelvic CT with immediate and delayed images when there is suspicion of renal injury. (Clinical Principle)

Clinicians should use non-invasive management strategies in hemodynamically stable patients with renal injury. (Strong, B)

The surgical team must perform immediate intervention (surgery or angioembolization in selected situations) in hemodynamically unstable patients with no or transient response to resuscitation. (Strong, B)

Clinicians may initially observe patients with renal parenchymal injury and urinary extravasation. (Clinical Principle)

Clinicians should perform follow-up CT imaging for renal trauma patients having either:

• (a) deep lacerations (AAST Grade IV-V) or
• (b) clinical signs of complications (e.g., fever, worsening flank pain, ongoing blood loss, abdominal distention).

(Moderate, C)

Clinicians should perform urinary drainage in the presence of complications, such as enlarging urinoma, fever, increasing pain, ileus, fistula or infection. (Moderate, C)