Haematuria after blunt trauma: the role of pyelography

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.