TABLE 2542 Grading of Renal Injuries4

MEATAL BLOOD Blood at the meatus is associated with urethral injuries. Urethral injuries are almost exclusively seen in males. Posterior urethral injuries are commonly associated with pelvic fractures. A superiorly displaced prostate indicates disruption of the posterior urethra. Anterior urethral injuries are associated with straddle injuries and instrumentation.

When meatal blood is noted, a urinary catheter should not be placed in order to prevent the conversion of a partial urethral laceration into a complete transection. A retrograde urethrogram is virtually mandatory in this setting.

HEMATURIA For the purposes of trauma, microscopic hematuria is defined as more than five red blood cells (RBCs) per high-power field (hpf). A 10-mL specimen must be centrifuged for 5 min at 2000 revolutions for an accurate assessment. Gross hematuria is, of course, readily visible blood. Reddish urine does not necessarily indicate hematuria; several medications and toxic substances may cause discoloration ( T§bl®..254.:3). Also, results of a dipstick evaluation may be erroneous, since myoglobin, a frequent finding in major trauma, reacts with the reagent.

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