Haematuria after blunt trauma: the role of pyelography

Abstract

This study is a combined prospective and retrospective review of 208 patients presenting with haematuria after blunt abdominal trauma. One hundred and twelve patients had an urgent intravenous pyelogram (IVP) with cystogram performed, while the remaining ninety-six were observed with serial urinalysis without any further investigation. Nineteen of the twenty-three patients with a positive IVP had gross haematuria and the remaining four had microscopic haematuria. Twenty-two of the patients with an abnormal IVP had positive abdominal signs, whilst only one case (with severe head injury) had no abdominal signs. In the 96 cases who were observed without IVP no complications occurred. It is suggested that if certain clinical criteria are observed most patients with post-traumatic microscopic haematuria can safely be spared an IVP. Indications for emergency IVP should include: gross haematuria or microscopic haematuria associated with abdominal signs or severe head injury or fracture of pelvis or spine. Had these criteria been observed during this study, 130 patients (62 per cent) would have avoided the risks and expenses of an IVP, and no significant urological injury would have been missed.

Review of the evidence on the management of blunt renal trauma in pediatric patients

“…Some have advocated that the decision to image pediatric patients should be the same as adults with regard to renal trauma [9][10][11][12]. However, using hypotension as the only indicator for the need for imaging in the traumatized child is cautioned against as children may have a greater physiologic reserve and may not demonstrate the effects of bleeding from severe renal injury as reliably as in the adult [13].…”