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Trauma urologico 1
- 1. TRAUMA UROLOGICO R1CG DELGADO
- 2. Trauma Urologico • Tracto superior Truma renal Trauma ureteral • Tracto inferior Trauma vesical Uretral • Traumatismo de genitales externos ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 3. Epidemiologia • Trauma principal causa de muerte en personas <40 años • 12% de muertes en México • Trauma urologico 2-5% • 10% Trauma abdominal ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 4. TRAUMA UROLOGICO 65% 1% 22% 3% 7%
- 5. TRAUMA RENAL
- 6. TRAUMA RENAL • Incidencia estimada de 4,9 por 100.000 habitantes • > Incidencia en varones 3:1 ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 7. Trauma renal Mecanismo de lesión Cerrado 85-90% • Contusion directa • Contragolpe • Desaceralcion Abierto 4-5% • Arma Blanca • Arma de fuego 28-30% intervencion quirurgica • 60% lesión de organos vecinos ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 11. Organ Injury Severity Scale • Journal of Trauma, 2011 • Predicts the need for surgery • Need for surgery ; nephrectomy rates: – Grade I: 0 ; 0% – Grade II: 15 ; 0% Santucci et al. Validation of the American Association for the – Grade III: 76 ; 3% Surgery of Trauma Organ Injury Severity Scale for the Kidney. J – Grade IV: 78 ; 9% Trauma; 50:195-200; 2011. – Grade V: 93 ; 86%
- 12. Diagnostico • EF: dolor lumbar, equimosis en flanco, fracturas costales • Micro y macrohaturia (36% no presentan) • Dipstick 97% especificidad y sensibilidad ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 13. Gross « Hematuria »: False + • Alphamethyldopa • Ibuprofen • Levodopa • Metronidazole • Nitrofurantoin • Phenazopyridine • Phenolphtalein-containing laxatives • Rifampin • Beets/berries
- 14. Criterios para estudio • Adulto con hematuria pica • Adulto con hematuria pica y lica < 90 mmHg (choque) • Todo < 16 os con hematuria sin importar el grado • Sospechoso: trauma contuso por n n sin hematuria • Toda n penetrante n sin hematuria
- 15. Diagnostico • USG S-80%, E-85%
- 16. • UROGRAFIA ENDOVENOSA S-82 Y E-85
- 18. Arteriografía S-89 Y E-91
- 19. TAC S-95 Y E-97 •
- 20. GRADO ll
- 21. GRADO lll
- 22. GRADO IV
- 25. • 90% Tratamiento conservador
- 34. TRAUMA URETERAL
- 35. Trauma ureteral • 1-3 % Trauma Genitourinario • 75% Iatrogénica, • 18% Traumatismo cerrado • 7% Trauma penetrante. Lesiones iatrogénicas • 73% Ginecológicos en origen • 14% eran de cirugía general • 12% urológico ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 36. 10% 15% 75%
- 38. Diagnostico • Sospecharla: mecanismo lesión, fiebre, • leucocitosis, irritación local peritoneal • Hematuria • Reconocimiento intraoperatorio Estudios de imagen • Urografía excretora • TAC • Pielografía anterógrada o retrógrada
- 42. AAST Ureteral Injury Scaling
- 43. TRATAMIENTO • Lesion I y ll Colocacion de sonda de Nefrostomia Colocacion de cateter ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 52. TRAUMA VESICAL
- 53. Trauma vesical • 22% Trauma urologico • Traumatismos cerrados representan 67% y el 86% • 70-90% asociacion con fractura pelvica • Trauma penetrante 14-33% • Iatrogenos 3-4% • H-M 3:1 • Niños aumenta frecuencia ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 54. Tipo de lesion ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 55. Extraperitoneal
- 57. Intraperitoneal
- 60. Diagnostico • Signos y síntomas Incapacidad para orinar Hematuria macroscópica Dolor abdominal Dolor pélvico Abdómen agudo ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 61. Clinical Presentation •Morey AF et al. Bladder rupture after blunt trauma : guidelines for diagnostic imaging. Journal of Trauma-Injury Infections & Critical Care. 51(4): 683-6, 2010 Oct. • 98%: Gross hematuria • 85% Pelvic ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 62. Diagnostico • Estudio elección: cistograma de llenado 350- 400ml solución salina, con 4% de contraste a una altura de infusión de 40 cm. ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 65. Diagnostico • Cystography: Gold standard • CT Cystography : New trend • Peng et al. AJR 2011. – Prospective study – 305 patients. – Cystography VS. CT cystography – Ruptures confirmed by Surgery – 100% sensitive and specific ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 69. Tratamiento Contusion/Grado l Uso de sonda Foley de 22-24Fr en caso de hematuria Extraperitoneales Conservador en 80% ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 70. Tratamiento • Intraperitoneal (20% mortalidad) • Pentrantes QUIRURGICO
- 74. TRAUMA URETRAL
- 75. Generalidades • 3-4% Lesion tracto urinario • H-M 3:1 • Lesion de uretra posterior • Lesion de urtera anterior ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 77. Fractura de uretra posterior 90% Causa de Fracturas Pelvianas Accidentes de trafico Caidas de grandes alturas
- 80. Lesion de uretra posterior Fractura de Malgainge 2.8%
- 81. Fractura en alas de mariposa 3.8%
- 82. Fractura en alas de maripos + diastasis articulacion sacroiliaca 24.2%
- 83. Cuadro clinico • Triada Hematuria + Uretrorragia + Retención aguda Hematoma perianal Prostata elevada
- 87. Retrograde Urethrogram: Interpretation • Contrast extravasation + Contrast in bladder PARTIAL Tear • Contrast extravasation only COMPLETE Tear
- 88. Partial Tear
- 89. Complete Tear
- 90. • Contusiones Cistostomia repeticion de uretrografia retrograda en 2 semanas
- 91. Tratamiento • Lesiones completas Cistostomia por 3-6 meses Tratamiento quirurgico posterior en 100% de pacientes Reparacion en primer tiempo Alto indice impotencia e incontinencia
- 93. • Tratamiento actual Realinamineto endoscopico o diferido en 10-14 dias Tratamiento diferido con uretroplastia posterior
- 95. Uretra posterior • 80-85% Secundario a trauma contuso • 20-25% Se acompaña con trauma peneano
- 98. Signos y síntomas Anterior • Uretrorragia • Dolor perineal • Hematoma perineal • Edema del área genital ó perineal • Tacto rectal normal ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 99. TRATAMIENTO • Cistostomia por 2-4 semanas • Tratamiento quirurgico 3-6 meses • Uretroplastia anterior
- 100. TRAUMA GENITAL EXTERNO RICG DELGADO
- 101. Traumatismo Genital externo • 4-8 % Traumatismo urologico • H-M 3:1 • 15-40 años de edad ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 102. Traumatismo de Pene 1 por cada 175 000 habitantes EEUU y Europa: el acto sexual Asia: Masturbación detumescencia Medio Oriente: Detumescencia Abiertos y cerrados Cerrado 60% ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 103. AAST ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 104. Cerrado • Contuso • Atrapamiento o estrangulacion • Fractura de pene ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 105. Contusión
- 106. Estrangulacion
- 108. Fractura
- 111. Avulsion
- 112. Herida penetrante
- 113. Amputación
- 114. Clinica • Dolor 20% • Chasquido 15% • Edema 30% • Hematoma 40% • Uretrorrgia16% • Reteción urinaria 5% ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 115. Diagnostico • Palpacion de hematoma • Incurvarcion • Uretrografia retrograda • Cavernosografia • USG Doppler • RMN ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 122. Tratamiento • Contusiones leves Antibiotico, Antinflamatorios y frio local • Contusion con hematoma Colocacion de sonda (tipo Foley 14-16F) Drenaje de hematoma ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 131. Avulsion
- 132. Amputacion 8 a 10 hrs maximo
- 133. Amputacion
- 140. Traumatismo escrotal y su contenido
- 141. Traumatismo escrotal y su contenido • 15% Traumatismo Genitourinarios • 20-25 años de edad • Actividad laboral y deportes • Cerrado y Penetrantes • Cerrado 75% ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 142. AAST ESCROTO ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 143. AAST TESTICULO ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 144. Escroto • Equimosis • Hematoma • Hematocele • Hidrocele • Ruptura de gubernaculum testis ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 148. Contenido escrotal Cerrado • Contusiones • Hematomas • Migración • Desgarro de albuginea • Rotura testicular ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 149. Contenido escrotal Abierto Laceracion Perforaciones Avulsión ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 155. Diagnostico • Clinica • USG • USG DOPPLER
- 158. Tratamiento • Hematomas Observación Profilaxis antibiotica Analgesia ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.
- 159. Tratamiento ,Safir M, Mario LA, Service S, Segal MR.American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2010;50(2):195-200.