Traumatic Hematuria

Patients sustaining blunt or penetrating trauma may have associated genitourinary injuries that can present as gross, microscopic, or no hematuria. Gross hematuria is defined as readily visible and microscopic hematuria as >5 RBC/hpf. Rapid and accurate evaluation and diagnosis may prevent serious complications. The differential diagnosis includes renal, ureteral, bladder, and urethral injury. In general, genitourinary injuries are the least life threatening, but are most likely to affect long-term quality of life with respect to their complications.

Physical examination is focused on the abdomen and external genitalia. Blood at the meatus, a high-riding prostate on digital rectal examination, and hematoma of the penis, scrotum, or perineum are signs of a urethral injury. In this case, catheterization should not be performed until urethral integrity is ascertained. Fractured ribs, flank tenderness, and flank ecchymosis (Grey-Turner sign) are associated with renal injuries. Inability to void, lower abdominal pain, and pelvic fractures are associated with bladder injuries. In stable, conscious patients, urine is collected by clean-catch technique. In more seriously injured patients, urethral catheterization should be performed if there is no blood at the urethral meatus in order to monitor the patient’s urine output.