This document discusses genitourinary trauma. It begins by outlining the most common locations of GU trauma, with the kidney being the most frequently injured organ at 67%. It then provides detailed classifications and imaging findings for injuries to the kidney, ureter, bladder, urethra and external genitalia. CT is highlighted as the preferred imaging modality for evaluating renal trauma due to its ability to accurately assess the entire abdomen. Imaging findings are described for each grade of renal injury on CT and management guidelines emphasize initial conservative treatment for most blunt trauma injuries.
Renal trauma is the most common genitourinary injury, accounting for 84% of cases. The kidneys are vulnerable to blunt trauma from motor vehicle accidents or falls. Computed tomography is the gold standard for evaluation and allows grading of injuries from Grade 1 to 5 based on the extent of laceration or devitalized tissue. Most Grade 1-3 injuries can be managed conservatively with bed rest, but higher grades or hemodynamic instability may require surgical exploration or nephrectomy. Ureteric injuries are less common, usually from penetrating trauma or surgery, and often diagnosed during laparotomy for other injuries.
This document discusses genitourinary trauma. It covers renal trauma in detail, including that renal injuries make up about 10% of emergency room visits for trauma. It presents the American Association for the Surgery of Trauma classification system for renal injuries in detail. It also discusses trauma to the bladder and ureters, management principles, and complications.
This document provides an overview of renal trauma, including epidemiology, modes of injury, classification systems, diagnostic evaluation, disease management, and complications. It discusses the American Association for the Surgery of Trauma renal injury grading scale and recommendations for initial patient evaluation, laboratory tests, and imaging modalities like CT, US, and IVP. Treatment options include conservative management with observation, angioembolization for bleeding injuries, and surgical exploration for hemodynamic instability or high-grade injuries. The goal is to control hemorrhage while salvaging the kidney through reconstruction when possible.
Dr. Abdellatif Zayed discusses various types of genitourinary trauma including renal, ureteral, bladder, and urethral injuries. Renal injuries are most commonly caused by blunt trauma from car accidents and are typically minor. Ureteral injuries require surgical repair depending on the location of the injury. Bladder injuries can be intraperitoneal, extraperitoneal, or a combination and are treated with exploration and repair or catheterization. Urethral injuries involve the anterior or posterior urethra and are managed with suprapubic catheterization and delayed repair when possible to reduce complications.
This document discusses various types of genitourinary trauma, including renal, bladder, ureteral, and scrotal trauma. It provides details on the mechanisms, classifications, imaging findings, and treatment approaches for each type of injury. Radiology plays an important role in accurately diagnosing and grading genitourinary trauma in order to guide clinical management decisions. CT is often the preferred imaging modality due to its ability to simultaneously evaluate the kidneys, bladder, and other abdominal organs.
Renal trauma can be caused by either penetrating or blunt injuries. Blunt trauma accounts for 90-95% of renal injuries and is often caused by motor vehicle accidents or falls. The American Association for the Surgery of Trauma (AAST) classification system grades renal injuries from 1 to 5 based on CT or surgical findings, with higher grades indicating more severe parenchymal lacerations or vascular injuries. Computed tomography (CT) with contrast is the gold standard for evaluating stable patients with renal trauma as it can detect lacerations, extravasation, and vascular injuries.
This document discusses urethral trauma, including classification, etiology, clinical manifestations, investigations, and principles of management. It separates discussions of posterior and anterior urethral injuries. For posterior injuries, immediate suprapubic cystostomy is standard, while delayed reconstruction is typically done via open posterior urethroplasty after 3 months. Anterior injuries may be treated with catheter diversion or primary realignment, while anastomotic urethroplasty is preferred for obliterated bulbar urethras after several weeks.
Renal trauma is the most common genitourinary injury, accounting for 84% of cases. The kidneys are vulnerable to blunt trauma from motor vehicle accidents or falls. Computed tomography is the gold standard for evaluation and allows grading of injuries from Grade 1 to 5 based on the extent of laceration or devitalized tissue. Most Grade 1-3 injuries can be managed conservatively with bed rest, but higher grades or hemodynamic instability may require surgical exploration or nephrectomy. Ureteric injuries are less common, usually from penetrating trauma or surgery, and often diagnosed during laparotomy for other injuries.
This document discusses genitourinary trauma. It covers renal trauma in detail, including that renal injuries make up about 10% of emergency room visits for trauma. It presents the American Association for the Surgery of Trauma classification system for renal injuries in detail. It also discusses trauma to the bladder and ureters, management principles, and complications.
This document provides an overview of renal trauma, including epidemiology, modes of injury, classification systems, diagnostic evaluation, disease management, and complications. It discusses the American Association for the Surgery of Trauma renal injury grading scale and recommendations for initial patient evaluation, laboratory tests, and imaging modalities like CT, US, and IVP. Treatment options include conservative management with observation, angioembolization for bleeding injuries, and surgical exploration for hemodynamic instability or high-grade injuries. The goal is to control hemorrhage while salvaging the kidney through reconstruction when possible.
Dr. Abdellatif Zayed discusses various types of genitourinary trauma including renal, ureteral, bladder, and urethral injuries. Renal injuries are most commonly caused by blunt trauma from car accidents and are typically minor. Ureteral injuries require surgical repair depending on the location of the injury. Bladder injuries can be intraperitoneal, extraperitoneal, or a combination and are treated with exploration and repair or catheterization. Urethral injuries involve the anterior or posterior urethra and are managed with suprapubic catheterization and delayed repair when possible to reduce complications.
This document discusses various types of genitourinary trauma, including renal, bladder, ureteral, and scrotal trauma. It provides details on the mechanisms, classifications, imaging findings, and treatment approaches for each type of injury. Radiology plays an important role in accurately diagnosing and grading genitourinary trauma in order to guide clinical management decisions. CT is often the preferred imaging modality due to its ability to simultaneously evaluate the kidneys, bladder, and other abdominal organs.
Renal trauma can be caused by either penetrating or blunt injuries. Blunt trauma accounts for 90-95% of renal injuries and is often caused by motor vehicle accidents or falls. The American Association for the Surgery of Trauma (AAST) classification system grades renal injuries from 1 to 5 based on CT or surgical findings, with higher grades indicating more severe parenchymal lacerations or vascular injuries. Computed tomography (CT) with contrast is the gold standard for evaluating stable patients with renal trauma as it can detect lacerations, extravasation, and vascular injuries.
This document discusses urethral trauma, including classification, etiology, clinical manifestations, investigations, and principles of management. It separates discussions of posterior and anterior urethral injuries. For posterior injuries, immediate suprapubic cystostomy is standard, while delayed reconstruction is typically done via open posterior urethroplasty after 3 months. Anterior injuries may be treated with catheter diversion or primary realignment, while anastomotic urethroplasty is preferred for obliterated bulbar urethras after several weeks.
This document discusses genitourinary trauma, focusing on injuries to the upper and lower urinary tract. It covers the etiology, clinical findings, imaging, and management of renal injuries, ureteral injuries, and bladder injuries. Renal injuries are the most common genitourinary injuries and are often caused by blunt trauma from motor vehicle accidents. Contrast-enhanced CT is the preferred imaging method to evaluate renal injuries. Most renal injuries can be managed non-operatively with bed rest and IV fluids, while operative management is indicated for persistent bleeding or expanding hematomas.
Bladder injuries may result from blunt,Penetrating and Iatrogenic trauma.
Full bladder is more susceptible to injury than empty bladder.
Management varies from conservative to surgical aiming to directly repair the injury.
Renal trauma can occur from blunt or penetrating injuries. Evaluation involves stabilizing the patient, assessing for life-threatening injuries using ATLS protocols, and obtaining imaging. CT is the preferred imaging method and allows grading of injuries according to the AAST scale. Most grade I-III injuries can be managed conservatively with observation. Higher grade injuries may require angioembolization or surgery to control bleeding. Goals of management are to control hemorrhage and salvage renal tissue when possible. Patients require follow-up imaging and monitoring for early or delayed complications.
- Up to 90% of renal injuries are due to blunt trauma from accidents.
- CT scan is now the preferred imaging modality for evaluating renal trauma as it can identify injuries like lacerations, hematomas, and vascular injuries.
- Renal injuries are classified based on the Federle scale from Grade I (contusion) to Grade V (shattered kidney or main renal artery injury).
Acute scrotal pain can be caused by many conditions, but the most common are testicular torsion and epididymitis. A thorough clinical examination is important to distinguish between these and other causes like trauma. Testicular torsion is a urological emergency requiring urgent surgical intervention, as delayed treatment can result in loss of the testis. Epididymitis is usually treated with antibiotics as an outpatient. Ultrasound is useful to confirm diagnoses and determine if surgical intervention is needed.
Renal injuries can occur from either blunt or penetrating abdominal trauma. Blunt injuries are more common and cause 90% of renal injuries. Injuries are classified from Grade I to Grade V based on severity. Minor injuries (Grades I-II) can often be managed non-operatively with monitoring but major injuries (Grades III-V) may require surgery, especially if there is continued bleeding or other serious injuries. Complications can include bleeding, infection, urinomas, and long term issues like hypertension if not properly treated. Surgery is aimed at repairing or removing injured portions of the kidney while preserving functioning tissue.
This document provides an overview of genitourinary trauma, including injuries to the penis, testicles, urethra, bladder, ureters and kidneys. It discusses the causes, signs, investigations and management for each type of injury. Penile fractures require surgical repair to prevent long-term complications. Testicular injuries may require ultrasound or surgical exploration. Urethral injuries are classified using the Goldman system and managed conservatively or surgically depending on severity. Bladder injuries often require retrograde cystography and may be managed conservatively or surgically. Renal injuries are graded based on CT or IVP findings and most grade I-II injuries can be managed conservatively while grade III or higher often require
This document provides an overview of urologic trauma, including the incidence, anatomy, mechanisms of injury, diagnosis, classification systems, and management principles for injuries to the ureter, bladder, and urethra. Key points include that ureteral injuries occur most commonly in the distal third, within the pelvis. Bladder injuries are often associated with pelvic fractures from blunt trauma. Urethral injuries are classified using the AAST grading system from 1 to 5 based on the extent of disruption. Management depends on the injury grade, with lower grades often stented or catheterized, while higher grades may require endoscopic realignment or delayed reconstruction.
This document discusses urethral stricture disease, including its definition, risk factors, presentation, diagnosis, and various treatment options. It provides details on endoscopic treatments like dilation and urethrotomy, as well as surgical options like urethroplasty repairs using grafts, flaps, and anastomoses. Five case examples are presented and management options discussed. Key points covered include techniques for anastomotic repairs, the use of buccal mucosa grafts, and monitoring after treatment. Current controversies regarding urethroplasty utilization and outcomes are also noted.
The ureters are tubular structures that transport urine from the kidneys to the bladder. They have multiple layers including epithelium, smooth muscle, and adventitia. Sites of natural narrowing include the ureteropelvic junction (UPJ) and ureterovesical junction. UPJ obstruction is most common in boys and on the left side. It can be caused by intrinsic narrowing at the UPJ or extrinsic compression. Surgical intervention is considered if renal function declines or symptoms develop. Treatment options include open or laparoscopic pyeloplasty, endopyelotomy, or ureterocalycostomy depending on the specifics of each case.
This document discusses the management of abdominal trauma. It begins with classifications for abdominal injuries and describes the pathophysiology of blunt and penetrating trauma. The primary and secondary surveys are outlined, including important physical exam findings. Diagnostic imaging options are presented, such as FAST ultrasound, CT scans, and DPL. Specific injuries to organs like the spleen are discussed. Management approaches for both blunt and penetrating trauma are covered, including options for non-operative management versus laparotomy. Damage control resuscitation principles and abdominal compartment syndrome are also mentioned.
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
The document discusses urethral stricture, which refers to scarring in the urethra that narrows the passageway for urine. It describes the anatomy of the male urethra and its divisions. Common causes of urethral stricture include trauma, infections like gonorrhea, prolonged catheterization, and complications after surgery. Left untreated, stricture can lead to urinary retention, infections, kidney damage from back pressure, and fistula formation. Symptoms include weak urinary stream and sudden retention.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
This document discusses urethral injury, including its definition, classification, etiology, management, and complications. Urethral injury occurs when there is trauma that breaches the structural integrity of the urethra. It is an increasingly common urologic injury due to factors like industrialization and advances in surgery. Urethral injuries are classified based on location (anterior vs posterior) and type (contusion, partial rupture, complete rupture). Timely diagnosis and management are important to reduce long-term morbidity. Complications can include stricture, erectile dysfunction, and incontinence.
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
Ureteropelvic junction obstruction by\ Eman Salman
It was used for student presentation in Urology course rotation
I Hope you find what is helpful for your knowledge ♥
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
This document discusses urinary tract trauma, focusing on kidney injuries. It notes that kidney injuries account for 67% of GU trauma and are usually blunt. CT scan is the preferred imaging modality. The Federle and AAST classification systems for renal injuries are described, grading injuries from I-V in severity. Grade I are minor injuries like contusions. Higher grades involve deeper lacerations, vascular injuries, and devascularized or shattered kidneys. CT findings for each grade are provided with examples. Other imaging modalities like ultrasound, IVU, and angiography are also discussed.
This document discusses genitourinary trauma, focusing on renal trauma. It notes that the kidney is the most commonly injured genitourinary organ. Renal trauma is most often blunt, with severe cases associated with injuries to other organs. CT scan is the preferred imaging modality to evaluate renal injuries according to the American Association for the Surgery of Trauma classification system, which grades injuries from I to V based on severity. Grade I injuries involve contusions or small lacerations without urine extravasation. Grade II injuries include larger lacerations or hematomas confined to the kidney. Grade III injuries involve deeper lacerations or vascular injuries with contained bleeding.
This document discusses genitourinary trauma, focusing on injuries to the upper and lower urinary tract. It covers the etiology, clinical findings, imaging, and management of renal injuries, ureteral injuries, and bladder injuries. Renal injuries are the most common genitourinary injuries and are often caused by blunt trauma from motor vehicle accidents. Contrast-enhanced CT is the preferred imaging method to evaluate renal injuries. Most renal injuries can be managed non-operatively with bed rest and IV fluids, while operative management is indicated for persistent bleeding or expanding hematomas.
Bladder injuries may result from blunt,Penetrating and Iatrogenic trauma.
Full bladder is more susceptible to injury than empty bladder.
Management varies from conservative to surgical aiming to directly repair the injury.
Renal trauma can occur from blunt or penetrating injuries. Evaluation involves stabilizing the patient, assessing for life-threatening injuries using ATLS protocols, and obtaining imaging. CT is the preferred imaging method and allows grading of injuries according to the AAST scale. Most grade I-III injuries can be managed conservatively with observation. Higher grade injuries may require angioembolization or surgery to control bleeding. Goals of management are to control hemorrhage and salvage renal tissue when possible. Patients require follow-up imaging and monitoring for early or delayed complications.
- Up to 90% of renal injuries are due to blunt trauma from accidents.
- CT scan is now the preferred imaging modality for evaluating renal trauma as it can identify injuries like lacerations, hematomas, and vascular injuries.
- Renal injuries are classified based on the Federle scale from Grade I (contusion) to Grade V (shattered kidney or main renal artery injury).
Acute scrotal pain can be caused by many conditions, but the most common are testicular torsion and epididymitis. A thorough clinical examination is important to distinguish between these and other causes like trauma. Testicular torsion is a urological emergency requiring urgent surgical intervention, as delayed treatment can result in loss of the testis. Epididymitis is usually treated with antibiotics as an outpatient. Ultrasound is useful to confirm diagnoses and determine if surgical intervention is needed.
Renal injuries can occur from either blunt or penetrating abdominal trauma. Blunt injuries are more common and cause 90% of renal injuries. Injuries are classified from Grade I to Grade V based on severity. Minor injuries (Grades I-II) can often be managed non-operatively with monitoring but major injuries (Grades III-V) may require surgery, especially if there is continued bleeding or other serious injuries. Complications can include bleeding, infection, urinomas, and long term issues like hypertension if not properly treated. Surgery is aimed at repairing or removing injured portions of the kidney while preserving functioning tissue.
This document provides an overview of genitourinary trauma, including injuries to the penis, testicles, urethra, bladder, ureters and kidneys. It discusses the causes, signs, investigations and management for each type of injury. Penile fractures require surgical repair to prevent long-term complications. Testicular injuries may require ultrasound or surgical exploration. Urethral injuries are classified using the Goldman system and managed conservatively or surgically depending on severity. Bladder injuries often require retrograde cystography and may be managed conservatively or surgically. Renal injuries are graded based on CT or IVP findings and most grade I-II injuries can be managed conservatively while grade III or higher often require
This document provides an overview of urologic trauma, including the incidence, anatomy, mechanisms of injury, diagnosis, classification systems, and management principles for injuries to the ureter, bladder, and urethra. Key points include that ureteral injuries occur most commonly in the distal third, within the pelvis. Bladder injuries are often associated with pelvic fractures from blunt trauma. Urethral injuries are classified using the AAST grading system from 1 to 5 based on the extent of disruption. Management depends on the injury grade, with lower grades often stented or catheterized, while higher grades may require endoscopic realignment or delayed reconstruction.
This document discusses urethral stricture disease, including its definition, risk factors, presentation, diagnosis, and various treatment options. It provides details on endoscopic treatments like dilation and urethrotomy, as well as surgical options like urethroplasty repairs using grafts, flaps, and anastomoses. Five case examples are presented and management options discussed. Key points covered include techniques for anastomotic repairs, the use of buccal mucosa grafts, and monitoring after treatment. Current controversies regarding urethroplasty utilization and outcomes are also noted.
The ureters are tubular structures that transport urine from the kidneys to the bladder. They have multiple layers including epithelium, smooth muscle, and adventitia. Sites of natural narrowing include the ureteropelvic junction (UPJ) and ureterovesical junction. UPJ obstruction is most common in boys and on the left side. It can be caused by intrinsic narrowing at the UPJ or extrinsic compression. Surgical intervention is considered if renal function declines or symptoms develop. Treatment options include open or laparoscopic pyeloplasty, endopyelotomy, or ureterocalycostomy depending on the specifics of each case.
This document discusses the management of abdominal trauma. It begins with classifications for abdominal injuries and describes the pathophysiology of blunt and penetrating trauma. The primary and secondary surveys are outlined, including important physical exam findings. Diagnostic imaging options are presented, such as FAST ultrasound, CT scans, and DPL. Specific injuries to organs like the spleen are discussed. Management approaches for both blunt and penetrating trauma are covered, including options for non-operative management versus laparotomy. Damage control resuscitation principles and abdominal compartment syndrome are also mentioned.
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
The document discusses urethral stricture, which refers to scarring in the urethra that narrows the passageway for urine. It describes the anatomy of the male urethra and its divisions. Common causes of urethral stricture include trauma, infections like gonorrhea, prolonged catheterization, and complications after surgery. Left untreated, stricture can lead to urinary retention, infections, kidney damage from back pressure, and fistula formation. Symptoms include weak urinary stream and sudden retention.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
This document discusses urethral injury, including its definition, classification, etiology, management, and complications. Urethral injury occurs when there is trauma that breaches the structural integrity of the urethra. It is an increasingly common urologic injury due to factors like industrialization and advances in surgery. Urethral injuries are classified based on location (anterior vs posterior) and type (contusion, partial rupture, complete rupture). Timely diagnosis and management are important to reduce long-term morbidity. Complications can include stricture, erectile dysfunction, and incontinence.
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
Ureteropelvic junction obstruction by\ Eman Salman
It was used for student presentation in Urology course rotation
I Hope you find what is helpful for your knowledge ♥
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
This document discusses urinary tract trauma, focusing on kidney injuries. It notes that kidney injuries account for 67% of GU trauma and are usually blunt. CT scan is the preferred imaging modality. The Federle and AAST classification systems for renal injuries are described, grading injuries from I-V in severity. Grade I are minor injuries like contusions. Higher grades involve deeper lacerations, vascular injuries, and devascularized or shattered kidneys. CT findings for each grade are provided with examples. Other imaging modalities like ultrasound, IVU, and angiography are also discussed.
This document discusses genitourinary trauma, focusing on renal trauma. It notes that the kidney is the most commonly injured genitourinary organ. Renal trauma is most often blunt, with severe cases associated with injuries to other organs. CT scan is the preferred imaging modality to evaluate renal injuries according to the American Association for the Surgery of Trauma classification system, which grades injuries from I to V based on severity. Grade I injuries involve contusions or small lacerations without urine extravasation. Grade II injuries include larger lacerations or hematomas confined to the kidney. Grade III injuries involve deeper lacerations or vascular injuries with contained bleeding.
This document summarizes renal injury from trauma. It notes that most renal injuries are minor (grades I-II) from blunt force and can be treated non-operatively. Imaging depends on stability and signs of injury. CT is recommended for penetrating injuries or those with gross hematuria. Major injuries (grades IV-V) involving fragmentation or devascularization of over 50% of the kidney often require nephrectomy. Minor injuries like contusions usually resolve without treatment.
This document discusses upper urinary tract trauma including renal and ureteric injuries. It covers the typical causes, imaging findings, and classifications of renal trauma including contusions, lacerations, hematomas, and vascular injuries. CT is usually the preferred initial imaging method. Most minor renal injuries can be managed conservatively but major injuries sometimes require surgery or percutaneous drainage. Ureteric injuries are less common and may appear as extravasation, hydronephrosis, or discontinuity on IVU or CT. Long-term complications can include hypertension, infection, or calculi formation if not properly treated.
Please find the power point on Urinary Tract Injury (Kidney Injury). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
The document outlines the evaluation and management of liver trauma in children. The liver is prone to blunt injury due to its friable parenchyma and fixed position. Most liver injuries in children are caused by deceleration or crush injuries from blunt trauma. Hemodynamic stability guides management, with conservative treatment sufficient for most grades I-III injuries. Operative treatment is considered for grades IV-V or if the patient is unstable. The mortality rate for liver trauma has significantly decreased over the past century with advances in care.
Imaging abdomen trauma renal part 5 Dr Ahmed EsawyAHMED ESAWY
Renal trauma can occur in 8-10% of patients with abdominal injuries, with blunt trauma being more common than penetrating injuries. CT imaging is important for evaluating renal trauma and detecting injuries such as hematomas, lacerations, and arterial extravasation. Renal injuries are classified into 5 grades based on the severity of the laceration and whether it involves the renal cortex, medulla, or collecting system. Active bleeding appears as areas of high attenuation on contrast-enhanced CT scans.
This document describes various imaging techniques used to evaluate the kidneys, including plain X-rays, ultrasound, intravenous urography, pyelography, arteriography, computed tomography, magnetic resonance imaging, and radionuclide studies. It also discusses renal biopsy indications, contraindications, complications, and how to prepare for the procedure. The imaging techniques can identify renal and urinary tract abnormalities while renal biopsy provides kidney tissue for analysis.
The kidneys are susceptible to injury from blunt or penetrating trauma due to their location and mobility. Blunt trauma is more common and can cause contusions, minor lacerations, major lacerations, or vascular injuries. Patients may experience pain, hematuria, flank masses or swelling. Treatment depends on the injury but involves controlling hemorrhage, infection and preserving renal function. Minor injuries are often managed conservatively with bed rest while more severe injuries like lacerations or vascular injuries may require surgery. Nursing care focuses on frequent assessment, education, monitoring for complications, and follow up to preserve long term kidney function.
Renal trauma can be caused by either penetrating or blunt injuries. Blunt trauma accounts for 90-95% of renal injuries and is often caused by motor vehicle accidents or falls. The American Association for the Surgery of Trauma (AAST) classification system grades renal injuries from 1 to 5 based on CT or surgical findings, with higher grades indicating more severe parenchymal lacerations or vascular injuries. Computed tomography (CT) with contrast is the gold standard for evaluating stable patients with renal trauma as it can detect lacerations, extravasation of urine, and vascular injuries.
The document discusses liver trauma, providing details on the anatomy and physiology of the liver, classifications of traumatic liver injuries, clinical presentations, diagnostic imaging approaches including CT scans and angiography, and treatments. Key points covered include: the liver is the second most commonly injured abdominal organ from trauma but most common cause of death; injuries are often from blunt force such as motor vehicle accidents; CT scans are the diagnostic standard and can classify injuries on a scale of I-VI based on features like hematomas and lacerations; angiography can identify active bleeding for potential embolization treatment.
The document discusses renal trauma, providing details on:
1) The anatomy, embryology, and blood supply of the kidneys.
2) Classification of renal injuries from Grade I to V based on severity.
3) Evaluation of renal trauma patients including history, exam, laboratory tests, ultrasound, IVU, CT, and angiography.
4) Management approaches including non-operative for lower grades and exploration for higher grades or hemodynamic instability.
This document discusses urological trauma, with a focus on renal and ureteral trauma. Some key points:
- Renal trauma occurs in 1-5% of all traumas and is the most common trauma to the urinary tract. It is usually caused by high-energy blunt trauma.
- Evaluation involves initial stabilization, then examination, urinalysis to check for hematuria, imaging like CT scan to assess injury grade and associated injuries.
- Treatment depends on injury grade, ranging from bed rest for grade I to exploration for grade V or instability. Surgical exploration priorities include control of hemorrhage, repair of associated injuries, and drainage of expanding hematomas.
- U
This document describes 10 cases of urinary system imaging findings. Case 1 describes x-ray and CT findings of xanthogranulomatous pyelonephritis and staghorn calculus in an elderly female. Case 2 describes CT findings of transitional cell carcinoma of the renal pelvis in a 68-year-old woman. Case 3 describes CT findings of renal infarction in a patient with rheumatic heart disease and flank pain. The remaining cases describe various urinary system conditions and imaging findings including percutaneous nephrostomy (Case 4), bladder stone (Case 5), retrograde pyelogram (Case 6), neurogenic bladder (Case 7), papillary necrosis (Case 8), pheochromocytoma
1) Liver trauma is the second most common organ injured in blunt abdominal trauma and the most common injured in penetrating trauma, occurring in 1-8% of patients with multiple blunt trauma.
2) The liver is susceptible to injury due to its size, friable parenchyma, thin capsule, and fixed position near the ribs and spine.
3) Liver injuries are classified based on the mechanism of injury, type and degree of damage, localization within liver lobes/segments, and whether associated vessels or bile ducts are damaged. Grades I-II are minor injuries while Grades III-V require surgical intervention and Grade VI is incompatible with survival.
This document discusses renal trauma, including causes, evaluation, grading, management, and complications. The key points are:
- Renal trauma occurs in 1-5% of all trauma cases and is most commonly caused by blunt force injuries from motor vehicle accidents or falls.
- Computed tomography is the gold standard for evaluation as it can detect lacerations, hematomas, and vascular injuries. Injuries are graded I to V based on severity.
- Most grade I-III injuries can be managed non-operatively with bed rest and monitoring. Grade IV-V or injuries with signs of continued bleeding typically require angiography or surgery.
- Surgical exploration is indicated for hemodynamic instability
This document discusses ureteral injuries, including their causes, presentation, diagnosis, and management. The most common cause of ureteral injury is iatrogenic from difficult pelvic surgery. Clinical presentation depends on the type and severity of injury, and may include hematuria, urine leakage, infection, or renal failure. Diagnosis involves imaging like CT, IVU, or retrograde pyelography. Management aims to restore ureteral continuity through techniques like stenting, excision with reanastomosis, or interposition grafts depending on the level and extent of injury. Proper identification and protection of the ureter during surgery can help prevent these
The document provides information on liver injury including:
- Liver injury occurs in approximately 5% of trauma admissions and mortality has decreased from 62.5% to 27.7% with advances in care.
- CT scan is used to grade liver injuries from I-VI based on factors like laceration depth and presence of bleeding or vascular injury.
- 85-89% of stable patients with blunt liver injury can be managed non-operatively though complications like bile leak or abscess can occasionally occur.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. Renal trauma
• 90% - Blunt, 10%-Penetrating
• 10% of pts with significant abdominal trauma.
• When severe, associated with injuries to other
organs in upto 80%.
• When kidney is the only organ damaged,
injury is minor in 98%.
4. Mechanism of renal trauma
• Blunt trauma: direct blow to the kidney.
• Penetrating trauma: stab or gunshot injury,
renal biopsy.
• High-velocity deceleration: pedicle injury
(avulsion of renal vessels).
6. Indications for renal imaging
• Penetrating
• Gross hematuria
• Microhematuria with shock( Systolic BP<90 mmHg)
• Microhematuria with
- Flank impact(contusion, haematoma over frank)
• Fracture of lower ribs, transverse processes or thoracolumbar
spine
• Deceleration injury
• Paediatric
7. Federle Classification
• Category I- MINOR
-Contusion
-Cortical laceration not extending into a calyx.
• Category II- MAJOR
-Cortical laceration extending into the collecting system(renal
fracture)
• CategoryIII- CATASTROPHIC
-Renal pedicle injuries
-Shattered kidney
• Category IV
-PUJ Injuries.
8. AAST (American Association for the Surgery of Trauma) Classification
• Grade 1
– Contusions
– Nonexpanding subcapsular hematomas
• Grade 2
– Superficial cortical lacerations less than 1 cm in depth without collecting
system injury
• Grade 3 –
– Renal lacerations greater than 1 cm in depth that do not involve the
collecting system
• Grade 4
– Renal lacerations extending to the corticomedullary junction or into the
collecting system
– Injuries involving the main renal artery or vein with contained hemorrhage
• Grade 5
– Shattered kidney
– Renal pedicle avulsion
12. IVU
• Historical interest, largely replaced by cross sectional imaging.
• Quality of IVU in the setting of trauma is likely to be poor;
hypotensive patient minimal or no secretion from both
kidneys.
• Single shot IVU(full length film 15 mins after contrast inj.)in
hemodynamically unstable patients destined for ER
laparotomy.
• Provides information regarding:
-presence of functioning contralateral kidney.
-some gross information about the injured kidney.
• Intra-operative IVU in severely injured patients.
13. IVU
• Absence of unilateral excretion:major vascular injury
(usually RA avulsion)
• Soft tissue swelling with loss of psoas outline:
retroperitoneal, perinephric and subcapsular
hematomas.
• Disruption of PCS:extravasation of opacified urine
(70% sensitivity for urine leak)
14. 15 min single shot IVU in a pt with stab injury to back. IVU-normal kidneys
and ureter bilaterally.
15. USG
• Advantages:
easily available, non invasive, high negative predictive
value(96-98%)
• Disadvantages:
-poor resolution (compared to CT)
-does not provide information about renal function.
-significant trauma may be missed(upto 80%of
parenchymal lesions may be overlooked)
16. Findings in USG
• Acute parenchymal, subcapsular and
perinephric hematomas - echo poor areas.
• More heterogenous and echogenic with time.
• Disruption of renal parenchyma with capsular
tears and urinomas can be identified
• Doppler-pedicle injuries.
17. Ultrasound gray-scale image shows normal right kidney.Doppler study shows
absent colour uptake in intrarenal arteries s/o grade 5 injury.
18. Grade 4 renal injury. Sonogram in an 8-year-old child with posttraumatic renal
infarction shows both kidneys with an avascular area in the lower half of the affected
kidney
19. CT Scan
• Modality of choice, most accurate technique.
• Allows assessment of entire abdomen,
including liver and spleen.
• Arteriovenous phase
• Delayed scan at 10-20 min
20. • Technique:
- the abdomen and pelvis should be scanned from the
diaphragmatic dome to pubic symphysis with contrast.
-Protocol:
• commence scanning 30 sec after the start of an injection of
50-100ml of 300 strength contrast at 2-3 ml/sec, collimation 7
mm, pitch 1.3, reconstruction interval of 7 mm.
21. CT Findings:Grade I Injuries
• Contusions and/or non expanding subcapsular hematomas.
-accounts for 80% of renal injuries.
• Contusions:
-ill-defined or sometimes sharply marginated areas of
reduced enhancement and excretion.
• Sucapsular hematoma:
-crescentic low density area following the convexity of the
outer aspect of the renal cortex
22. Grade 1 renal injury, contusion-shows ill-defined area of
hypoenhancement in the medial right kidney.
23. Grade 1 renal injury, subcapsular hematoma-Image shows crescentic high-
density fluid collection around the left kidney with well-defined outer margin
25. Grade 2&3 Injuries
• Grade2: non expanding perinephric hematomas contained by the
retroperitoneum and superficial cortical lacerations less than 1 cm in
depth not extending into a calyx.
• Grade3: cortical lacerations greater than 1 cm in depth not extending into
a calyx.
• Perinephric hematoma :
-ill-defined, hyperattenuating fluid collection located between the Gerota
fascia and the renal parenchyma
• Renal lacerations :
-jagged or linear parenchymal disruptions that can contain fresh or
clotted blood .
• Both grade 2 and grade 3 renal lacerations :No evidence of urinary
contrast extravasation on delayed CT.
26. Grade 2 renal trauma-an ill-defined fluid collection in the left perinephric
space andsubcapsular hematoma with deformity of the renal parenchyma.
27. Grade 2 renal injury-superficial (less than 1 cm deep) renal
parenchymal defect with a large perinephric hematoma
28. Grade 3 renal laceration, CT-renal parenchymal defect with extension greater than 1
cm deep to near the renal pelvis
30. Grade 4 Injuries
• A) renal lacerations that extend into the collecting system,
B) injuries to the main renal artery or vein with contained hemorrhage, and
C)segmental infarctions without associated lacerations.
• Renal lacerations with collecting system involvement :
- frequently produce extravasation of urine or contrast agent.
-delayed images allow adequate views of any urinary extravasation
• Renal segmental infarctions: well-delineated, linear or wedge-shaped, often
multifocal and nonenhancing areas that extend through the parenchyma in a
radial or segmental orientation .
31. Grade 4 renal injury segmental infarction. Shows a segmental area of
nonenhancement in the upper medial left kidney without associated renal laceration.
32. Grade 4-5 renal injury shows deep lacerations extending into the collecting system of
the right kidney . Extension into the collecting system is confirmed by urinary contrast
extravasation on the delayed image through the kidney in excretory phase.
33. Grade 5 Injuries
• Shattered or devascularized kidney, UPJ avulsions, and complete
laceration or thrombosis of the main renal artery or vein.
• Shattered kidney: multiple renal fragments.
• Renal artery disruption/avulsion: commonest vascular injury.
-non perfusion of the kidney.
-some preservation of peripheral perfusion due to early take off of the
capsular artery.
-traumatic renal artery dissection may be identified on CT.
• Traumatic renal vein thrombosis.
-persistent nephrogram,
-thrombus may be directly demonstrated in the renal vein.
• UPJ avulsion-contrast extravasation
-total disruption-ureter fails to opacify.
-partial disruption-contrast appears in the ureter.
36. Grade 5 renal injury. Shattered kidney with renal vein thrombosis (incomplete). CT
scan shows shattered right kidney and renal vein thrombus extending slightly into the
inferior vena cava.
37. Grade 5 renal injury, devascularization. CECT shows dissection of the origin of
the left renal artery, with no perfusion of the left kidney.
38. MRI
• MRI provides excellent detail of the renal
anatomy but offers no clear advantage over
CT, and is less able to detect extravasation.
• A rare indication for MRI in the renal trauma
setting may be severe contrast allergy.
41. Ureteric trauma
• <1% of urinary tract trauma
• Mechanism of injury:
a) External:
Penetrating injuries
Deceleration injuries:
-PUJ avulsion,
-less often upper 1/3rd
of ureter
-more frequent in children(sufficient flexibilty
to produce hyperflexion injuries)
b) Iatrogenic: gynaecologic Surgery for malignancy.
43. • Haematuria may be absent in one third of
cases.
Features include:
• Contrast extravasation
• Formation of urinoma
• Ureteric discontinuity
44. Imaging findings
• IVU:
-mild to moderate fullness of the PCS and extravasation at the
site of tear.
- complete tear-ureter fails to opacify below the tear.
-fistulations to other structures.
• Retrograde pyelogram:
-findings as above.
-limited use in acute setting.
46. • Blunt trauma:
- most common in patients with multi injury trauma
- predisposed by full bladder at the time of trauma.
- pelvic fractures(especially anterior ring) commonly
asscociated
-7 % symphysis pubis diastasis associated with bladder
trauma.
• Spontaneous:
• pre-existing bladder wall abormalities &/or excessive
straining
-bladder tumour,cystitis,perivesical inflammation,
BOO,neurogenic bladder,previous radiotherapy.
47. • Iatrogenic trauma
Surgery particularly caessarean section
and transurethral bladder resection( usually
for tumour)
48. Classification
1 Contusion (incomplete or partial tear of the bladder mucosa,imaging
findings usually normal)
2 Intraperitoneal rupture (contrast material seen around bowel loops
and in the major peritoneal spaces)
3 Interstitial bladder injury(rare, contrast material dissects into bladder
wall but not outside the bladder)
4 Extraperitoneal rupture (contrast seen within the perivesical
space and a variable number of adjacent extraperitoneal
spaces, depending upon the severity of injury)
5 Combined intraperitoneal and extraperitoneal rupture.
50. Conventional Cystography
• Advantages:
-nearly 100% sensitive for detecting rupture, provided that
adequate distention is accomplished and that post voiding
images are obtained.
• Disadvantages:
-time consuming,
-require extra radiography in addition to necessary trauma
evaluation.
-not useful in evaluating trauma to other viscera.
51. CT cystography
• Advantages of CT Cystography
-less time consuming.
-concomitant injury to other viscera(most
importantly the kidneys)
• The absence of free fluid in the abdomen
during the CT is a strong negative predictor of
bladder injury.
52. Imaging findings
• Extraperitoneal rupture:
-commonest bladder injury(90% of cases)
-associated anterior pelvic ring fracture in 90% of cases.
-extravasation of contrast into the perivesical space-
- in florid extravasation,contrast may extend
anterosuperiorly along the anterior pelvic and
abdominal wall upto umbilicus,or posteriorly around
the rectum in presacral space.
-associated tear of urogenital diaphragm allowing the
contrast to appear within the perinerum,thigh and
scrotum.
• The extravasated contrast stays close to the bladder and has a sharp
irregular margins.
53. CT cystogram of victim of motor vehicle collision
(A) shows streaky extravasated contrast material around
urinary bladder consistent with extraperitoneal bladder injury.
(B) Coronal reformatted image better demonstrates the site of
injury at the left bladder base
54. • Intraperitoneal rupture
-contrast extravasates into the peritoneal
cavity and has a more cloudy nebulous
appearance.
-usually tear is along the dome of bladder
which is the weakest part.
-associated pelvic fractures seen in 75%
57. Urethral trauma
• Almost entirely restricted to males unless
there is major pelvic trauma in females.
• Should be suspected-
– Pelvic trauma with hematuria or retention
– Blood at the urethral meatus.
Imaging: Retrograde urethrogram
58. Male posterior urethral injuries
Type Membranous
urethra
Bulbar Urethra Contrast
Extravasation
Perineu
m
Retropu
bic
space
I Contusion or
partial tear
Normal or
stretced
No No
II Rupture
above UGD
Normal or
stretched
No Yes
III Rupture
below UGD
Ruptured Yes No
59.
60. • Type II injuries-most common,rupture at the
prostatic apex (prostatomembranous
junction) immediately above the UGD with
sparing of the UGD itself.
• Type III injuries-membranous urethra ruptures
at the membranobulbar junction below the
UGD,which itself is disrupted.
61. Retrograde urethrogram reveals a type I urethral injury with minimal stretching and
slight luminal irregularity of the posterior urethra. No extravasation of contrast
material is present
62. Retrograde urethrogram - type II urethral disruption. Extravasation of contrast
material (solid arrow) from the posterior urethra is seen superior to an intact
urogenital diaphragm (dashed arrow).
63. Retrograde urethrogram - type III urethral injury. Extravasation is located in both the
extraperitoneal pelvis and in the perineum (above and below the urogenital
diaphragm).
64. Anterior urethral trauma
• Mechanisms:
-iatrogenic (attempted catheterisation,
instrumentation)
-blunt perineal trauma(straddle injury):bulbar
urethra and corpus spongiosum are
compressed against the inferior aspect of
anterior pelvic ring.
65. Straddle injury. Retrograde urethrogram shows a type 5 urethral injury with
extravasation of contrast material from the distal bulbous urethra.
68. SCROTAL TRAUMA
• Injury to the testis may occur from
penetrating wounds, direct impact of high-
velocity objects against the testis or
compression of the testis against the pubic
arch and impacting object.
• Ultrasound is the imaging technique of choice
in acute scrotal trauma.
69. • Intratesticular haematomas are common after
trauma.
• The ultrasound appearance depends on the
time between occurrence of trauma and
ultrasound evaluation.
• Acute haematomas are typically isoechoic to
the normal testicular parenchyma and can be
difficult to identify.
70.
71. • Testicular rupture implies tearing of the tunica
albuginea with extrusion of testicular
parenchyma into the scrotal sac.
• The margins of the testis are poorly defined
and the echogenicity of the testis is
heterogeneous.
72. • The use of colour Doppler is essential as
rupture of the tunica albuginea will almost
always be associated with a loss of vascularity
to a portion of or the entire testis.
73. • Trauma to the testis can also result in dislocation
or torsion.
• Dislocation most commonly results from impact
of the scrotum against the fuel tank in
motorcycle accidents.
• Testicular dislocation, typically into the inguinal
canal, may be detected by CT or ultrasound.
• Testicular torsion is preceded by trauma in 5–8%
of cases.
74. References
• Textbook of radiology and imaging David
Sutton 7th
edition
• Grainger and Allison’s Diagnostic Radiology 6th
edition
• Fundamentals of Diagnostic Radiology Bryant
& Helms 4th
edition
• Radiopedia
Editor's Notes
Major renal injury(grade 4 and 5):
- up to 25% of blunt, and in up to 70% of penetrating renal trauma cases.
(more ant location and proximity to rigid spine or iliac crest)
? omit if normal kidneys with no perinephric, retroperitoneal or pelvic fluid.
addition of 400-600 ml of oral contrast (4% diatriazoate) immediately before scan helps in delineating associated
bowel injuries (stomach,duodenum and proximal jejunum).