Date post: | 17-Dec-2015 |
Category: |
Documents |
Upload: | neal-davis |
View: | 223 times |
Download: | 0 times |
Liping Xie
Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University
Urogenital Trauma
Urogenital Trauma
Renal & Ureteral InjuryBladder InjuryUrethral InjuryInjuries of the external genitalia
Three to 10% of trauma patients have GU involvement; 10-15% of trauma patients with abdominal injuries have GU involvement.
Renal Injury
Renal injuries constitute 45% of all GU injuries;
Most renal injuries (80%) are minor and do not require surgical intervention;
Renal trauma can happen in both blunt or penetrating trauma;
Renal injuries are most commonly from motor vehicle accidents (MVAs);
Renal InjuryPhysical examination: Flank ecchymosis or mass indicates a
retroperitoneal process but is not specific to renal injuries and rarely occurs acutely.– The most important indicator of renal trauma
is gross or microscopic hematuria.– The absence of hematuria, although rare,
does not exclude renal injury because it is absent in 5% of patients.
Radiographic Staging IVP - double dose CT Scan - best method of staging - radiog
raphic study of choice Ultrasound Angiography - used for suspected renovas
cular injury
Renal Injury
Ureteral Injury
Ureteral injuries after external violence are rare, occurring in less than 4% of cases of penetrating trauma and less than 1% cases of blunt trauma.
Ureteral injuries after external violence, unlike renal injuries, are difficult to detect with the usual array of diagnostic tools.
Ureteral Injury
Excretory urography demonstrating extravasation in the upper right ureter consequent to stab wound (Arr
ow)
Bladder InjuryBladder injuries classified into contusions, extraperitoneal and intraperitoneal ruptures ;
Intraperitoneal (20%)
Extraperitoneal (80%)
Rupture
A full bladder is more likely to become injured than an empty one.
Bladder Injury
mostly occur in blunt trauma. Eighty-five percent of these injuries occur with pelvic fractures;
15% occur with penetrating trauma and blunt mechanism without a pelvic fracture (ie, full bladder blowout).
gross hematuria in the trauma setting requires imaging of both upper and lower urinary tract
Diagnosis
Cystogram and CT are helpful diagnostic tools. Cystogram (left) shows extraperitoneal bladder rupture with extravasation into scrotum. CT(right) reveals intraperitoneal bladder rupture with contrast material surroundin
g bowel loops
Urethra Injury
Almost exclusively in maleMost common in straddle injureSignificant morbidity
– Stricture– Incontinence– Impotence
Foley catheter implication
Urethra Injury
Gross hematuria in 98% Inability to void Blood at urethral meatus Pelvic / suprapubic
tenderness Penile / scrotal / perineal
hematoma Boggy / high-riding
prostate/ ill-defined mass on rectal examination.
More common than posterior
Direct trauma Usually NO pelvic injury Blood at meatus Unable to micturate Penile/Scrotal/Perineal
– Contusion– Hematoma– Fluid collection
Posterior Urethra- Anterior Urethra-
Contrast extravasation + Contrast in bladder
Contrast extravasation only
Urethrogram
PARTIAL Tear
COMPLETE Tear
retrograde urethrography via meatus
Extravasation of contrast medium with the “missing” bladder indicates a complete tear of
the urethra
Urethrogram
Management of Urethral Injury
Partial tear– careful passage of 12-14 Fr. Foley.– If any resistance: Urology
Complete tear:– Urology + suprapubic cath.
If Foley already there and suspect tear:– LEAVE FOLEY IN PLACE
IInitial urethral repair is not recommended nitial urethral repair is not recommended because of risk of hemorrhage, impotence, and because of risk of hemorrhage, impotence, and
infection of pelvic hematoma. infection of pelvic hematoma.
Penis– Penetrating, skin avulsion and amputation
repaired surgically– “fracture” repaired and drained surgically
Scrotum/testes– Hematocele and contusion (mild) or rupture
(severe, needs exploration)– Penetrating injuries need exploration
Injuries of the external genitalia