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Tue, 15 Jan 2002 08:03:55 EST

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In a message dated 1/15/2002 6:53:08 AM Eastern Standard Time, 
DocRickFry@aol.com writes:

> Phil--
> Gross hematuria first requires a simple cystogram right in the ER or trauma 
> center--just instill 250cc contrast thru the bladder catheter by gravity 
> and shoot a film, then a post-evac film.  The bladder is the most likely 
> injury to produce gross hematuria.  The reason to do this first is IF there 
> is intra-peritoneal extravasation, immediate laparotomy is indicated, and 
> you will not need a CT (I hope everyone understands this point of logic).  
> Any other finding and CT abdomen is indicated to view the rest of the GU 
> tract and other abdominal organs--hematuria is a marker for intraperitoneal 
> viscus injury.  If no findings on CT, and hematuria clears, no further 
> workup is necessary--this is a self-limited renal contusion.  Continued 
> hematuria mandates further workup.  In a stable patient, no injury found in 
> the kidney will require operation--just followup.  In an unstable patient, 
> of course, the CT would never have been done--patient will be in the OR or 
> angio
> ERF 

Rick
This simple cystogram that you describe will miss many bladder injuries. 

It has been shown that 250 ml of contrast will not detect all injuries. 400 
ml is the threshhold that I use. 

A lateral view is necessary before and after emptying the bladder. 

Finally I would never do a retrograde cystogram in any patient who looks like 
they need angiography to control their pelvic hemorrhage. Too much contrast 
extravasation from the bladder may obscure the sites of arterial bleeding on 
the angiogram. Leave the bladder until bleeding is controlled. 

Sal

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<HTML><BODY BGCOLOR="#ffffff">In a message dated 1/15/2002 6:53:08 AM Eastern Standard Time, DocRickFry@aol.com writes: 
 
 
<BLOCKQUOTE TYPE=CITE style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">Phil-- 
Gross hematuria first requires a simple cystogram right in the ER or trauma center--just instill 250cc contrast thru the bladder catheter by gravity and shoot a film, then a post-evac film.&nbsp; The bladder is the most likely injury to produce gross hematuria.&nbsp; The reason to do this first is IF there is intra-peritoneal extravasation, immediate laparotomy is indicated, and you will not need a CT (I hope everyone understands this point of logic).&nbsp; Any other finding and CT abdomen is indicated to view the rest of the GU tract and other abdominal organs--hematuria is a marker for intraperitoneal viscus injury.&nbsp; If no findings on CT, and hematuria clears, no further workup is necessary--this is a self-limited renal contusion.&nbsp; Continued hematuria mandates further workup.&nbsp; In a stable patient, no injury found in the kidney will require operation--just followup.&nbsp; In an unstable patient, of course, the CT would never have been done--patient will be in the OR or angio 
ERF </BLOCKQUOTE> 
 
Rick 
This simple cystogram that you describe will miss many bladder injuries. 
 
It has been shown that 250 ml of contrast will not detect all injuries. 400 ml is the threshhold that I use. 
 
A lateral view is necessary before and after emptying the bladder. 
 
Finally I would never do a retrograde cystogram in any patient who looks like they need angiography to control their pelvic hemorrhage. Too much contrast extravasation from the bladder may obscure the sites of arterial bleeding on the angiogram. Leave the bladder until bleeding is controlled. 
 
Sal</HTML>

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