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Commonly DividedCommonly Divided
1.1. KidneyKidney
2.2. UreterUreter
3.3. BladderBladder
4.4. Urethra andUrethra and
5.5. External genitaliaExternal genitalia
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The Primary GoalThe Primary Goal
Preserve the maximal ofPreserve the maximal of
functionalfunctional
inimi!ing the com"licationsinimi!ing the com"lications
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I. RENAL INJURIESI. RENAL INJURIES
1.1 to 5# of all trauma cases1.1 to 5# of all trauma cases
5$# of all %U trauma5$# of all %U trauma
Blunt trauma &$ ' ($#Blunt trauma &$ ' ($#
Penetrating trauma 1$ ' 2$#Penetrating trauma 1$ ' 2$#
a)ority grade 1* grade 2 to 5a)ority grade 1* grade 2 to 5+4# of ,lunt - /# of "enetrating+4# of ,lunt - /# of "enetrating
trauma0trauma0
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RENAL INJURIESRENAL INJURIES
nitial Evaluationnitial Evaluation
1.1. ematuriaematuria
2.2. Blunt traumaBlunt trauma
3.3. Penetrating trauma Penetrating trauma
a.a. %unshots%unshots,.,. ta, oundsta, ounds
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RENAL INJURIESRENAL INJURIES
ndications for 6enal magingndications for 6enal maging
1.1. Blunt trauma - %ross hematuriaBlunt trauma - %ross hematuria
2.2. Blunt trauma* micr. ematuria -Blunt trauma* micr. ematuria -
hoc7hoc7
3.3. 8cceleration or 9eceleration in)ury8cceleration or 9eceleration in)ury
4.4. Pediatric trauma "atientPediatric trauma "atient
5.5. 8ssociated in)ury8ssociated in)ury
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RENAL INJURIESRENAL INJURIES
maging tudymaging tudy
1.1. :; can:; can
2.2. ntavenous urogram +<U0ntavenous urogram +<U0
3.3. U%U%
4.4. 8rteriogra"hy8rteriogra"hy
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RENAL INJURIESRENAL INJURIES
n)ury caling +88;0n)ury caling +88;0
:ontusion = ematoma:ontusion = ematoma
ematoma = >aceration +ematoma = >aceration + ? 1 cm? 1 cm 00
>aceration +>aceration + @ 1 cm@ 1 cm 00
<< >aceration = <ascular in) - ;hrom,.>aceration = <ascular in) - ;hrom,.
<< >aceration +hattered0 = <ascular>aceration +hattered0 = <ascularavulsionavulsion
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RENAL INJURIESRENAL INJURIES
ndication for 6enal Ex"lorationndication for 6enal Ex"loration
1.1. Blunt ;raumaBlunt ;rauma +Aig. 10+Aig. 10
a.a. 8,solute indication8,solute indication.. Persistent -Persistent -
"otentially lifethreatening ,leeding"otentially lifethreatening ,leeding
,.,. 6elative indication6elative indication +9evitali!ed +9evitali!ed
"arenchym* Urinary extravasation*"arenchym* Urinary extravasation*incom"lite staging - 8rterialincom"lite staging - 8rterial
throm,0throm,0
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Blunt traumaBlunt trauma
Micr. Hematuria
& no shockMicr. Hematuria
& no shock
Renal imaging
Unnecessary exception:
Deceleration or multiple Associated injuries
Renal imaging
Unnecessary exception:
Deceleration or multiple Associated injuries
ross hemat. or
shock !ith micr Hross hemat. or
shock !ith micr H
"#ser$e"#ser$e
Unsta#leUnsta#le %ta#le%ta#le
xploratory laparotomy& single shot '()
xploratory laparotomy& single shot '()
*ormal '()*ormal '() A#normal '()"r inconclusi$e
A#normal '()
"r inconclusi$e
%ta#le retroperitonealhematoma
%ta#le retroperitonealhematoma
)ulsatile expanding"r uncontained
Retroperitonial hematoma
)ulsatile expanding"r uncontained
Retroperitonial hematoma
Renal explorationRenal exploration
A#dominal+, scan
A#dominal+, scan
Associated injuriesRe-uiring laparrotomy Associated injuries
Re-uiring laparrotomy
*o associatedinjury
*o associated
injury
rade ' or ''Renal injury
rade ' or ''Renal injury
grade '''(Renal injurygrade '''(
Renal injury
Renal
explorationRenal
exploration
rade ' / '''Renal injury
rade ' / '''Renal injury
rade '(Renal injuryrade '(
Renal injury
rade (Renal injuryrade (
Renal injury
Renal
explorationRenal
exploration
%electi$e renal
exploration%electi$e renal
exploration"#ser$e"#ser$e"#ser$e"#ser$e "#ser$e"#ser$e
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RENAL INJURIESRENAL INJURIES
2.2. Penetrating ;raumaPenetrating ;rauma +Aig. 20+Aig. 20
a.a. 8,solute indications8,solute indications
,.,. 6elative indications6elative indications
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Penetrating trauma
ematuria or sus"ectCf renal in)ury
Unsta,le or sus"ectedntra"eritonial in)ury
ta,le ith no sus"ectedntra"eritonial in)ury
Ex"loratory la"arotomy- singleshot <P
Dormal <P8,normal <P
Cr inconclusive
ta,le - containedtro"eritonial hematoma
Ex"anding*"ulsatileCr uncontained
6etro"eritonial hematoma
C,servation 6enal ex"loration
8,normal :; scan
%rade renal in)ury
%rade <6enal in)ury
%rade <6enal in)ury
C,servationelective renal
ex"loration6enal
ex"loration
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RENAL INJURIESRENAL INJURIES
anagementanagement
1.1. urgical methodesurgical methodes
2.2. Dono"erative - :onservativeDono"erative - :onservative
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RENAL INJURIESRENAL INJURIES
Dono"erative - :onservativeDono"erative - :onservative
1.1. trict ,ed resttrict ,ed rest
2.2. :lose monitoring of <:lose monitoring of <
3.3. ematocritematocrit
4.4.
Broads"ectrum anti,ioticBroads"ectrum anti,iotic5.5. ;ransfusion ;ransfusion
/./. 6eimaging6eimaging
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RENAL INJURIESRENAL INJURIES
:om"lications:om"lications
1.1. Early com"licationEarly com"lication
2.2. >ate com"lication>ate com"lication
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II. URETERAL & RENALII. URETERAL & RENAL
PELVIS INJURIESPELVIS INJURIES8. echanism of n)ury8. echanism of n)ury
1.1. External traumaExternal trauma
2.2. urgical traumaurgical trauma
a.a. Pelvic o"erationPelvic o"eration
,. atrogenic in)uriesin)uries +Urology*+Urology*GynecoloyGynecoloy* :olorectal -* :olorectal -
<ascular surgery<ascular surgery
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URETERAL & RENALURETERAL & RENAL
PELVIS INJURIESPELVIS INJURIESB. 9iagnosis of Ureteral n)uryB. 9iagnosis of Ureteral n)ury
1.1. Preo"erative diagnosisPreo"erative diagnosis
2.2. magingmaging
3.3. ntrao"erative diagnosisntrao"erative diagnosis
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URETERAL & RENALURETERAL & RENAL
PELVIS INJURIESPELVIS INJURIES:.:. :lassication:lassication
1.1. >ocation of the ureteral in)ury>ocation of the ureteral in)ury
2.2. echanism - manner of in)ury echanism - manner of in)ury
a.a. >igation>igation
,.,. ;ransection ;ransectionc.c. 8vusion +UPF0* etc8vusion +UPF0* etc
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URETERAL & RENALURETERAL & RENAL
PELVIS INJURIESPELVIS INJURIES9.9. 8ssociated n)uries8ssociated n)uries
1.1. Penetrating ureteral traumaPenetrating ureteral trauma
+($#0+($#0
2.2. Blunt ureteral trauma +#0Blunt ureteral trauma +#0
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URETERAL & RENALURETERAL & RENAL
PELVIS INJURIESPELVIS INJURIES2.2. 9istal Ureteral n)uries9istal Ureteral n)uries
a.a. UreteroneocystostomyUreteroneocystostomy
,.,. <esico"soas hitch<esico"soas hitch
c.c. ;ransureteroureterostomy ;ransureteroureterostomy
d.d. Cther "rocedures Boari Ga"*Cther "rocedures Boari Ga"*renal dis"lacement*renal dis"lacement*
autotrans"lantasionautotrans"lantasion
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URETERAL & RENALURETERAL & RENAL
PELVIS INJURIESPELVIS INJURIES3. idureteral - U""er Ureteral3. idureteral - U""er Ureteral
n)uriesn)uries UreteroureterostomyUreteroureterostomy
4. ;he unsta,le "atient4. ;he unsta,le "atienta.a. :utaneous Ureterostomy:utaneous Ureterostomy
,.,. Ureteral ligation folloed ,y a PDUreteral ligation folloed ,y a PD
c.c. 9enitive reconstruction is9enitive reconstruction isdelayeddelayed
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URETERAL & RENALURETERAL & RENAL
PELVIS INJURIESPELVIS INJURIES5.5. anagement of :om"lic -anagement of :om"lic -
9elayed 9=9elayed 9=
a.a. 9elayed recognition & ' 5#9elayed recognition & ' 5#
,.,. urgically ex"lored - re"airedurgically ex"lored - re"aired
c.c. PD - 9elayed reconstructionPD - 9elayed reconstruction
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III. !LADDER TRAU"AIII. !LADDER TRAU"A
&/# ,lunt a,dominal trauma&/# ,lunt a,dominal trauma
($# are associated "elvic fra7tur($# are associated "elvic fra7tur
(1/# of all "elvic fractures(1/# of all "elvic fractures
/$# extra* 3$# intra"eritonial/$# extra* 3$# intra"eritonial
1$12# are com,ined in)uries1$12# are com,ined in)uries
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!LADDER TRAU"A!LADDER TRAU"A
8.8. ign - ym"tomsign - ym"toms
1. Dearly all B. ru"t ith1. Dearly all B. ru"t ith hematuriahematuria
2.2. %ross hematuria%ross hematuria
a.a. Blunt in)uryBlunt in)ury ⇒⇒ (51$$#(51$$#
,.,.
Penetrating in)uryPenetrating in)ury ⇒⇒
5$#5$#
3. Pelvic = loer a,d. Pain3. Pelvic = loer a,d. Pain
4.4. na,ility to urinatena,ility to urinate
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!LADDER TRAU"A!LADDER TRAU"A
B.B. 8ssociated n)uries8ssociated n)uries
1.1. (4(# ith associated in)uries(4(# ith associated in)uries
2.2. Pelvic - long ,one fractures*Pelvic - long ,one fractures*
s"inal = visceral in)uriess"inal = visceral in)uries
3.3. ortality rate 1/53#ortality rate 1/53#
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!LADDER TRAU"A!LADDER TRAU"A
:.:. magingmaging
1.1. :ystoga"hy:ystoga"hy
a0a0 Bladder contusionBladder contusion
,0,0 ntestitial ru"turentestitial ru"ture
c0c0
ntra or Extra"eritoneal ru"turentra or Extra"eritoneal ru"ture
d0d0 >arge "elvic hematoma>arge "elvic hematoma
2.2. :; cystogra"hy:; cystogra"hy
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!LADDER TRAU"A!LADDER TRAU"A
9.9. anagement +Aig. 30anagement +Aig. 30
1.1. ntra"eritonealntra"eritoneal - "enetrating- "enetrating
,ladder in)uries,ladder in)uries
2.2. BluntBlunt extra"eritonealextra"eritoneal ,ladder,ladder
in)uries or interstitial ru"turesin)uries or interstitial ru"tures
3.3. Bladder nec7Bladder nec7
4.4. :om"lications:om"lications
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IV. URET#RAL INJURIESIV. URET#RAL INJURIES
6elatively uncommon6elatively uncommon
a)ority due to ,lunt traumaa)ority due to ,lunt trauma
9ivided into ant or "osterior9ivided into ant or "osterior
in)uriesin)uries
inimi!e com"licationsinimi!e com"lications
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URET#RAL INJURIESURET#RAL INJURIES
8.8. Posterior urethral in)uriesPosterior urethral in)uries
1./(.(# of "elvic fractures1./(.(# of "elvic fractures
:om"lete in 3# - "artial in:om"lete in 3# - "artial in
23#23#
Bladder nec7 or mem,ranousBladder nec7 or mem,ranous
urethral in)ury* direct lacerationurethral in)ury* direct laceration
and distractionand distraction
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URET#RAL INJURIESURET#RAL INJURIES
B. n)ury scaleB. n)ury scale +88;0+88;0
1.1. %rade %rade :ontusion :ontusion
2.2. %rade %rade tretch in)ury tretch in)ury
3.3. %rade %rade Partial disru"tion Partial disru"tion
4.4.
%rade <%rade <
:om"lete disru"tion :om"lete disru"tion
5.5. %rade <%rade < %rade < @ 2 :m %rade < @ 2 :m
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URET#RAL INJURIESURET#RAL INJURIES
:.:. igns - ym"tomsigns - ym"toms
1.1. Blood of the meatusBlood of the meatus
2.2. na,ility to voidna,ility to void3.3. 9istended ,ladder9istended ,ladder
4.4. %ross hematuria* non"al"a,le%ross hematuria* non"al"a,le
"rostate"rostate5.5. Perineal* scrotal or "enile hematomaPerineal* scrotal or "enile hematoma
/./. 9iHculty "assing a Aoley catheter9iHculty "assing a Aoley catheter
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URET#RAL INJURIES
9.9. magingmaging studies
1.1. KUB = Pelvic lmKUB = Pelvic lm
2.2. 6U%6U%
E.E. 8ssociated in)uriesin)uries
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URET#RAL INJURIES
A.A. %eneral management%eneral management
%oals Preserving%oals Preserving
:ontinence:ontinence
PotencyPotency
8voiding the "elvic hematoma8voiding the "elvic hematoma
infectioninfection
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URET#RAL INJURIES
%. :om"lete Urethral 9isru"tion%. :om"lete Urethral 9isru"tion
II :ontroversial I:ontroversial I
1.1. Primary suturingPrimary suturing
2.2. PE6PE6
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URET#RAL INJURIES
. Partial Urethral 9isru"tion. Partial Urethral 9isru"tion
II Urinary diversionUrinary diversionJJ
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URET#RAL INJURIES
.. Blunt 8nt. Urethral n)uriesBlunt 8nt. Urethral n)uries
1.1. :ontusions:ontusions
2.2. >acerations>acerations
F. F. Penetrating 8nt. Urethral n)uriesPenetrating 8nt. Urethral n)uries
1.1. %unshots%unshots
2.2. ta, oundsta, ounds
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$ATETERISASI$ATETERISASI
1.1. DAC6E9 :CDED;DAC6E9 :CDED;
2.2. Prola7sis +8nti,ioti70Prola7sis +8nti,ioti70
3.3. Posisi ;erlentang = >itotomiPosisi ;erlentang = >itotomi
4.4. 9esinfe7si9esinfe7si
5.5. nstillasi >ido7ain)ellynstillasi >ido7ain)elly
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;EDK ;EDK
LA$I%LA$ILA$I%LA$I
1.1. Penis 9ilurus7anPenis 9ilurus7an
2.2. asu77an Kateter 9g halusasu77an Kateter 9g halus3.3. Pasien Dafas Pelan -9alamPasien Dafas Pelan -9alam
4. 4. Tekanan halus & kontinyu PdTekanan halus & kontinyu PdSpinter Spinter
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;EDK ;EDK
Lai%LaiLai%Lai
asu77an sam"ai Perca,anganasu77an sam"ai Perca,angan
Balon Ai7sasi + 8Luadest 1$ cc 0Balon Ai7sasi + 8Luadest 1$ cc 0
am,ung dg Uro,agam,ung dg Uro,ag
Ai7sasi +nguinal = >i"at Paha0Ai7sasi +nguinal = >i"at Paha0
:atat Urin Mg Keluar:atat Urin Mg Keluar
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;EDK ;EDK
'ANITA'ANITA
1.1. >a,ium ayora 9i,u7a>a,ium ayora 9i,u7a
2.2. denti7asi Urethradenti7asi Urethra
3.3. asu77an 7ateter 9g alusasu77an 7ateter 9g alus
4.4. etelah Urin Keluar* ;erus7an 2etelah Urin Keluar* ;erus7an 2
ncinci
5.5. elan)utnya N >a7i>a7ielan)utnya N >a7i>a7i
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8dult ,lunt trauma
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Do ,lood at meatus Blood at meatus
ay "ass Aoley catheter 6U%
Urology consultematuria Do hematuria
C,serve:; or <P
a)or desc. in)%ross hematuria icrohematuria
<P = :; and:ystogram
C,srve Urology:onsult
hoc7 Do shoc7
<P = :; and:ystogram
PelvicAracture
Do"elvic fracture
:; or <Pa)or desc in)
C,serve:ystogram
C,serve Urology consult
Urology consult C,serve
Dormal
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Penetratingn)uries
emodynamicallyta,le
emodinamicallyUnsta,le
C"erating 6oom>oer chestAlan7=,ac7
8,domen
u"ra"u,ic
area
Penis crotum
8,dominal :;
C,servationUrology:onsult
8,dominal :;- :ystogram
C,servation
Urology consult- 6U%
f hematuriaUrology consult
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