Arteriography There is no relevant literature regarding the use of arteriography in the evaluation of penetrating trauma specific to the lower urinary tract. Arteriography can be useful in identifying an occult source of bleeding and can guide its subsequent therapeutic embolization [15]. Angioembolization has been described as a useful diagnostic and therapeutic tool in trauma patients with pelvic fractures and vascular injuries. US Pelvis Transabdominal ultrasound (US) findings in bladder rupture and urethral evaluation with an endorectal probe have been described in the setting of blunt trauma [15], but US has not been routinely used for evaluating penetrating trauma of the lower urinary tract. Conversely, most or all seriously injured trauma patients will likely be evaluated with CT because of its speed and accuracy of evaluation. US can be used to evaluate associated visceral lesions, such as solid or hollow organ rupture, and nonspecific peritoneal fluid [15]. The detection of peritoneal fluid in the presence of normal viscera or the failure to visualize the bladder after the transurethral introduction of saline are considered highly suggestive of bladder rupture [15]. As a practical matter, US is not definitive in bladder or urethral trauma and is almost never used for this diagnosis. Adequate distention of the urinary bladder is crucial to detecting a perforation, especially in instances of penetrating trauma, as most instances of a false-negative retrograde cystogram were found in this situation [24,25]. To exclude bladder injury, a filling volume of at least 350 to 400 mL of contrast should be achieved. The catheter balloon should not be tightly maintained against the bladder neck because it could tamponade against a disruption and prevent detection of a leak in this region. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list.
Penetrating Trauma Lower Abdomen and Pelvis. Arteriography There is no relevant literature regarding the use of arteriography in the evaluation of penetrating trauma specific to the lower urinary tract. Arteriography can be useful in identifying an occult source of bleeding and can guide its subsequent therapeutic embolization [15]. Angioembolization has been described as a useful diagnostic and therapeutic tool in trauma patients with pelvic fractures and vascular injuries. US Pelvis Transabdominal ultrasound (US) findings in bladder rupture and urethral evaluation with an endorectal probe have been described in the setting of blunt trauma [15], but US has not been routinely used for evaluating penetrating trauma of the lower urinary tract. Conversely, most or all seriously injured trauma patients will likely be evaluated with CT because of its speed and accuracy of evaluation. US can be used to evaluate associated visceral lesions, such as solid or hollow organ rupture, and nonspecific peritoneal fluid [15]. The detection of peritoneal fluid in the presence of normal viscera or the failure to visualize the bladder after the transurethral introduction of saline are considered highly suggestive of bladder rupture [15]. As a practical matter, US is not definitive in bladder or urethral trauma and is almost never used for this diagnosis. Adequate distention of the urinary bladder is crucial to detecting a perforation, especially in instances of penetrating trauma, as most instances of a false-negative retrograde cystogram were found in this situation [24,25]. To exclude bladder injury, a filling volume of at least 350 to 400 mL of contrast should be achieved. The catheter balloon should not be tightly maintained against the bladder neck because it could tamponade against a disruption and prevent detection of a leak in this region. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list.