1、Urogenital Trauma,Urogenital Trauma,Renal & Ureteral Injury Bladder Injury Urethral Injury Injuries 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 Injury,Renal injuries constitut
2、e 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 Injury Scale,Renal Injury,Physical examination: Flank ecchy
3、mosis 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 pati
4、ents.,Radiographic Staging IVP - double dose CT Scan - best method of staging - radiographic study of choice Ultrasound Angiography - used for suspected renovascular injury,Renal Injury,CT Staging for Renal Injury,Right renal stab wound (Grade IV),Management of Renal Injury,Surgical Management for R
5、enal Injury,Ureteral 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 ar
6、ray of diagnostic tools.,Ureteral Injury,Excretory urography demonstrating extravasation in the upper right ureter consequent to stab wound (Arrow),Surgical Management for Ureteral Injury,Bladder Injury,Bladder injuries classified into contusions, extraperitoneal and intraperitoneal ruptures ;,Intra
7、peritoneal (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 frac
8、ture (ie, full bladder blowout).gross hematuria in the trauma setting requires imaging of both upper and lower urinary tract,Bladder Injury,Diagnosis,Cystogram and CT are helpful diagnostic tools. Cystogram (left) shows extraperitoneal bladder rupture with extravasation into scrotum. CT(right) revea
9、ls intraperitoneal bladder rupture with contrast material surrounding bowel loops,Surgical Mangement of Bladder Rupture,Urethra Injury,Urethra Injury,Almost exclusively in male Most common in straddle injure Significant morbidity Stricture Incontinence Impotence Foley catheter implication,Urethra In
10、jury,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
11、 micturate Penile/Scrotal/Perineal Contusion Hematoma Fluid collection,Posterior Urethra-,Anterior Urethra-,Urethra Injury,EXTRAVASATION OF URINE,High Riding Prostate on DRE,Diagnosis,Urethrogram is the best diagnostic tool-,Urethrogram,Contrast extravasation + Contrast in bladderContrast extravasat
12、ion 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: Urolo
13、gy Complete tear:Urology + suprapubic cath. If Foley already there and suspect tear: LEAVE FOLEY IN PLACE,Initial urethral repair is not recommended because of risk of hemorrhage, impotence, and infection of pelvic hematoma.,Management of Urethral Injury,Surgical Repair,Banks Method,Penis Penetratin
14、g, 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,Injuries of the external genitalia,Penile fracture,scrotal hematoma after straddle injure,Thanks,
