The document reviews urological trauma, focusing on renal trauma. It provides details on the epidemiology, classification, investigations, and management of renal trauma. Key points include:
- Renal trauma accounts for 1-5% of all trauma cases and is most commonly caused by blunt mechanisms like motor vehicle collisions.
- CT scan with IV contrast is the standard imaging investigation, while angiography is recommended for persistent bleeding.
- Conservative management is recommended for stable patients with low grade injuries. Higher grade injuries or instability may require angiography or surgery.
- Operative intervention is indicated for hemodynamic instability, expanding hematomas, or high grade vascular injuries. Renal reconstruction should be attempted when possible.
Dx & Mx of urethral and bladder injuriesSCGH ED CME
This document discusses injuries to the bladder and urethra, providing details on diagnosis and management. It notes that bladder injuries occur in 1.6% of blunt trauma victims and are usually associated with pelvic fractures. Gross hematuria is present in most bladder injury cases. Urethral injuries in males are divided into those affecting the posterior urethra associated with pelvic fractures, and anterior injuries from blunt or penetrating trauma. Diagnosis is via retrograde cystography or urethrography. Most extraperitoneal bladder ruptures are now managed non-operatively with catheter drainage, while intraperitoneal ruptures require surgical repair. Urethral injuries may be treated with immediate surgical closure, catheter drainage
This document provides an overview of the management of urethral injuries. It begins with an introduction noting that urethral injuries are uncommon but management can be challenging. It then covers relevant anatomy, classifications of injuries, causes, clinical features, investigations, and various treatment approaches depending on the type and severity of injury. For posterior urethral injuries specifically, it describes classification systems and discusses options like suprapubic diversion, endoscopic realignment, and open urethroplasty. Complications are also reviewed. The conclusion emphasizes the need for proper initial assessment and management of these 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 injuries to the lower urinary tract, including the urinary bladder and urethra. It describes the etiology, classification, clinical features, investigations, complications, and treatment for injuries to these structures. Injuries to the urinary bladder can be extraperitoneal or intraperitoneal ruptures. Injuries to the urethra can involve the membranous or anterior portions. Treatment involves surgical repair or catheter drainage depending on the specific injury.
pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
This document provides an overview of genitourinary trauma, including injuries to the upper urinary tract (kidneys and ureters), lower urinary tract (bladder and urethra), and external genitalia. It discusses the etiology, clinical findings, imaging, and management of renal injuries, which are the most common genitourinary injuries. The staging of renal trauma and indications for operative versus nonoperative management are outlined. Surgical techniques for renal exploration, reconstruction, and nephrectomy are also reviewed.
Urethral injuries can be caused by blunt trauma such as motor vehicle accidents or falls, or penetrating injuries near the urethra. Injuries are classified as either posterior injuries involving the membranous or prostatic urethra, often associated with pelvic fractures, or anterior injuries distal to the membranous urethra from blunt perineal trauma. Diagnosis involves retrograde urethrography to detect extravasation of contrast at the injury site. Treatment depends on injury location and patient stability, often initially involving suprapubic catheter placement, with delayed repair of posterior injuries once hematomas resolve and associated injuries stabilize. Proper early management can lead to good long-term outcomes while
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.
Dx & Mx of urethral and bladder injuriesSCGH ED CME
This document discusses injuries to the bladder and urethra, providing details on diagnosis and management. It notes that bladder injuries occur in 1.6% of blunt trauma victims and are usually associated with pelvic fractures. Gross hematuria is present in most bladder injury cases. Urethral injuries in males are divided into those affecting the posterior urethra associated with pelvic fractures, and anterior injuries from blunt or penetrating trauma. Diagnosis is via retrograde cystography or urethrography. Most extraperitoneal bladder ruptures are now managed non-operatively with catheter drainage, while intraperitoneal ruptures require surgical repair. Urethral injuries may be treated with immediate surgical closure, catheter drainage
This document provides an overview of the management of urethral injuries. It begins with an introduction noting that urethral injuries are uncommon but management can be challenging. It then covers relevant anatomy, classifications of injuries, causes, clinical features, investigations, and various treatment approaches depending on the type and severity of injury. For posterior urethral injuries specifically, it describes classification systems and discusses options like suprapubic diversion, endoscopic realignment, and open urethroplasty. Complications are also reviewed. The conclusion emphasizes the need for proper initial assessment and management of these 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 injuries to the lower urinary tract, including the urinary bladder and urethra. It describes the etiology, classification, clinical features, investigations, complications, and treatment for injuries to these structures. Injuries to the urinary bladder can be extraperitoneal or intraperitoneal ruptures. Injuries to the urethra can involve the membranous or anterior portions. Treatment involves surgical repair or catheter drainage depending on the specific injury.
pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
This document provides an overview of genitourinary trauma, including injuries to the upper urinary tract (kidneys and ureters), lower urinary tract (bladder and urethra), and external genitalia. It discusses the etiology, clinical findings, imaging, and management of renal injuries, which are the most common genitourinary injuries. The staging of renal trauma and indications for operative versus nonoperative management are outlined. Surgical techniques for renal exploration, reconstruction, and nephrectomy are also reviewed.
Urethral injuries can be caused by blunt trauma such as motor vehicle accidents or falls, or penetrating injuries near the urethra. Injuries are classified as either posterior injuries involving the membranous or prostatic urethra, often associated with pelvic fractures, or anterior injuries distal to the membranous urethra from blunt perineal trauma. Diagnosis involves retrograde urethrography to detect extravasation of contrast at the injury site. Treatment depends on injury location and patient stability, often initially involving suprapubic catheter placement, with delayed repair of posterior injuries once hematomas resolve and associated injuries stabilize. Proper early management can lead to good long-term outcomes while
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 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.
Urethral and bladder injuries can occur from pelvic fractures or direct trauma. Posterior urethral injuries commonly occur from shearing forces in pelvic fractures and require initial suprapubic cystostomy with delayed repair to avoid complications. Anterior urethral injuries from straddle injuries may be contusions or lacerations, treated with catheterization or cystostomy depending on severity. Bladder injuries are often extraperitoneal from pelvic fractures and present as hematuria, diagnosed by cystography or CT cystography and treated with catheter drainage. Intraperitoneal bladder injuries require surgery.
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.
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.
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.
This document discusses complications of percutaneous nephrolithotomy (PCNL). It describes the most common complications as acute hemorrhage from the renal parenchyma or collecting system. Delayed hemorrhage can also occur due to arteriovenous fistulas or pseudoaneurysms. Collecting system injuries like tears or perforations need drainage with stents or nephrostomy tubes. Rare but serious complications include visceral injuries to nearby organs, pleural injuries, metabolic disturbances, and neurological issues from positioning. Management involves drainage, angioembolization, or open surgery depending on the complication. The document also reviews drainage techniques after PCNL including tubeless procedures with just ureteral stents or
This document summarizes the key topics in a rotation in urology, including the anatomy of the lower urinary tract and male genitalia, etiology of urethral injuries, clinical manifestations of urethral trauma, evaluation modalities, and management principles and techniques for urethral trauma including urethroplasty. Guidelines from the European Association of Urology are referenced.
This document provides an overview of common urologic emergencies and their management. It discusses renal colic caused by kidney stones, including pain management with NSAIDs and opioids. It also covers acute urinary retention, priapism, hematuria, and anuria. For each condition, it outlines evaluation, differential diagnosis, and treatment approaches including medical expulsive therapy, ureteral stenting, and surgical procedures.
The rectum receives its blood supply from three arteries. Rectal trauma is usually caused by penetrating injuries like gunshot or stab wounds, though blunt trauma from pelvic fractures can also cause injury. Diagnosis involves a digital rectal exam, proctosigmoidoscopy, and CT scan. Intraperitoneal injuries are managed like colon injuries with primary repair. Management of extraperitoneal injuries has evolved from routinely using colostomy, presacral drainage, and rectal washout, though new evidence questions the value of routine presacral drainage and rectal washout. Current treatment involves fecal diversion or primary repair depending on the injury, with presacral drainage only used for posterior injuries repaired via laparotomy
The document provides tips for using a PowerPoint presentation (PPT) for active learning sessions on medical topics. It recommends:
1) Freely editing, modifying, and adding your name to the PPT.
2) Noting that half the slides are blank except for the title to elicit student responses.
3) Showing blank slides, asking students what they know, and then showing the content slide.
4) Repeating this process of blank slide + student response + content slide at the end for reinforcement.
5) This active learning approach can be repeated over three sessions for effective learning.
1. Open ureterolithotomy is indicated for stones with a low likelihood of success with less invasive techniques or in areas without access to ureteroscopy or lithotripsy.
2. The procedure involves making an extraperitoneal or transperitoneal incision to access the ureter, dissecting and opening the ureter longitudinally over the stone, removing the stone, and closing the ureterotomy with sutures.
3. Postoperatively, patients are monitored for vital signs and urine output, given antibiotics and analgesics, and the drain is removed if output is low after 24 hours.
The document discusses the management of bladder injuries, outlining their causes, clinical presentation, investigations including cystography, complications, and treatment approaches which may involve nonsurgical management for minor injuries or surgical repair for more severe injuries involving the bladder wall or neck. Grading systems are used to classify injury severity to determine the appropriate treatment.
1) Bowel and mesenteric injuries occur in 1-5% of abdominal trauma cases and are difficult to diagnose due to non-specific clinical signs in 40% of cases and complications from polytrauma.
2) CT scanning is the preferred imaging modality for evaluating bowel and mesenteric injuries in hemodynamically stable patients, with a sensitivity of 70-85%. Common CT findings include bowel wall discontinuity, extraluminal air or contrast, and mesenteric stranding or hematoma.
3) The most common sites of bowel injury are the small bowel (jejunum and ileum), followed by the colon (transverse colon). Mesenteric injuries like bleeding require
1. Rectal injuries are becoming a major cause of death in India and can result from penetrating or blunt trauma.
2. The rectum has distinct anatomical regions and injuries are classified based on their depth and circumference according to the American Association for the Surgery of Trauma scale.
3. Treatment depends on whether the injury is intraperitoneal or extraperitoneal and may involve fecal diversion, distal washout, drainage, debridement, and repair or reconstruction of damaged sphincters. Accurate diagnosis and classification is important to guide appropriate surgical management of rectal injuries.
The document describes surgical procedures for removing kidney stones. It indicates that open surgery is still needed in cases of obstruction, infection, failed lithotripsy, or stones too large for other procedures. It then provides details on instruments, incisions, and techniques for simple pyelolithotomy, coagulum technique, extended pyelolithotomy, and managing stones extending into the ureteropelvic junction. The goal is to remove all stones and debris while minimizing damage to the kidney and ensuring the pelvis can be closed watertight.
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.
- 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).
This document discusses bladder injury, including causes, mechanisms, clinical features, investigations, and management. Bladder injury can occur from trauma like road accidents, falls, or instrumentation. Clinical features include suprapubic pain and inability to urinate. Investigations include cystography and CT scan. Treatment involves repairing the injury surgically, usually with sutures, drainage, and antibiotics to prevent complications.
This document discusses injuries to the genitourinary tract, including the kidney, ureter, bladder, and urethra. Kidney injuries are often caused by trauma and present with hematuria, pain, and palpable masses. Imaging studies like CT scans are used for diagnosis. Complications include hemorrhage, hydronephrosis, and abscesses. Ureter injuries can be caused by surgery or trauma and present with anuria, oliguria, pain, and hydronephrosis. Diagnosis involves tests like retrograde uretherography and treatment includes surgeries like ureteroureterostomia. Bladder injuries from trauma or surgery can be intraperitoneal or extraper
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.
Urethral and bladder injuries can occur from pelvic fractures or direct trauma. Posterior urethral injuries commonly occur from shearing forces in pelvic fractures and require initial suprapubic cystostomy with delayed repair to avoid complications. Anterior urethral injuries from straddle injuries may be contusions or lacerations, treated with catheterization or cystostomy depending on severity. Bladder injuries are often extraperitoneal from pelvic fractures and present as hematuria, diagnosed by cystography or CT cystography and treated with catheter drainage. Intraperitoneal bladder injuries require surgery.
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.
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.
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.
This document discusses complications of percutaneous nephrolithotomy (PCNL). It describes the most common complications as acute hemorrhage from the renal parenchyma or collecting system. Delayed hemorrhage can also occur due to arteriovenous fistulas or pseudoaneurysms. Collecting system injuries like tears or perforations need drainage with stents or nephrostomy tubes. Rare but serious complications include visceral injuries to nearby organs, pleural injuries, metabolic disturbances, and neurological issues from positioning. Management involves drainage, angioembolization, or open surgery depending on the complication. The document also reviews drainage techniques after PCNL including tubeless procedures with just ureteral stents or
This document summarizes the key topics in a rotation in urology, including the anatomy of the lower urinary tract and male genitalia, etiology of urethral injuries, clinical manifestations of urethral trauma, evaluation modalities, and management principles and techniques for urethral trauma including urethroplasty. Guidelines from the European Association of Urology are referenced.
This document provides an overview of common urologic emergencies and their management. It discusses renal colic caused by kidney stones, including pain management with NSAIDs and opioids. It also covers acute urinary retention, priapism, hematuria, and anuria. For each condition, it outlines evaluation, differential diagnosis, and treatment approaches including medical expulsive therapy, ureteral stenting, and surgical procedures.
The rectum receives its blood supply from three arteries. Rectal trauma is usually caused by penetrating injuries like gunshot or stab wounds, though blunt trauma from pelvic fractures can also cause injury. Diagnosis involves a digital rectal exam, proctosigmoidoscopy, and CT scan. Intraperitoneal injuries are managed like colon injuries with primary repair. Management of extraperitoneal injuries has evolved from routinely using colostomy, presacral drainage, and rectal washout, though new evidence questions the value of routine presacral drainage and rectal washout. Current treatment involves fecal diversion or primary repair depending on the injury, with presacral drainage only used for posterior injuries repaired via laparotomy
The document provides tips for using a PowerPoint presentation (PPT) for active learning sessions on medical topics. It recommends:
1) Freely editing, modifying, and adding your name to the PPT.
2) Noting that half the slides are blank except for the title to elicit student responses.
3) Showing blank slides, asking students what they know, and then showing the content slide.
4) Repeating this process of blank slide + student response + content slide at the end for reinforcement.
5) This active learning approach can be repeated over three sessions for effective learning.
1. Open ureterolithotomy is indicated for stones with a low likelihood of success with less invasive techniques or in areas without access to ureteroscopy or lithotripsy.
2. The procedure involves making an extraperitoneal or transperitoneal incision to access the ureter, dissecting and opening the ureter longitudinally over the stone, removing the stone, and closing the ureterotomy with sutures.
3. Postoperatively, patients are monitored for vital signs and urine output, given antibiotics and analgesics, and the drain is removed if output is low after 24 hours.
The document discusses the management of bladder injuries, outlining their causes, clinical presentation, investigations including cystography, complications, and treatment approaches which may involve nonsurgical management for minor injuries or surgical repair for more severe injuries involving the bladder wall or neck. Grading systems are used to classify injury severity to determine the appropriate treatment.
1) Bowel and mesenteric injuries occur in 1-5% of abdominal trauma cases and are difficult to diagnose due to non-specific clinical signs in 40% of cases and complications from polytrauma.
2) CT scanning is the preferred imaging modality for evaluating bowel and mesenteric injuries in hemodynamically stable patients, with a sensitivity of 70-85%. Common CT findings include bowel wall discontinuity, extraluminal air or contrast, and mesenteric stranding or hematoma.
3) The most common sites of bowel injury are the small bowel (jejunum and ileum), followed by the colon (transverse colon). Mesenteric injuries like bleeding require
1. Rectal injuries are becoming a major cause of death in India and can result from penetrating or blunt trauma.
2. The rectum has distinct anatomical regions and injuries are classified based on their depth and circumference according to the American Association for the Surgery of Trauma scale.
3. Treatment depends on whether the injury is intraperitoneal or extraperitoneal and may involve fecal diversion, distal washout, drainage, debridement, and repair or reconstruction of damaged sphincters. Accurate diagnosis and classification is important to guide appropriate surgical management of rectal injuries.
The document describes surgical procedures for removing kidney stones. It indicates that open surgery is still needed in cases of obstruction, infection, failed lithotripsy, or stones too large for other procedures. It then provides details on instruments, incisions, and techniques for simple pyelolithotomy, coagulum technique, extended pyelolithotomy, and managing stones extending into the ureteropelvic junction. The goal is to remove all stones and debris while minimizing damage to the kidney and ensuring the pelvis can be closed watertight.
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.
- 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).
This document discusses bladder injury, including causes, mechanisms, clinical features, investigations, and management. Bladder injury can occur from trauma like road accidents, falls, or instrumentation. Clinical features include suprapubic pain and inability to urinate. Investigations include cystography and CT scan. Treatment involves repairing the injury surgically, usually with sutures, drainage, and antibiotics to prevent complications.
This document discusses injuries to the genitourinary tract, including the kidney, ureter, bladder, and urethra. Kidney injuries are often caused by trauma and present with hematuria, pain, and palpable masses. Imaging studies like CT scans are used for diagnosis. Complications include hemorrhage, hydronephrosis, and abscesses. Ureter injuries can be caused by surgery or trauma and present with anuria, oliguria, pain, and hydronephrosis. Diagnosis involves tests like retrograde uretherography and treatment includes surgeries like ureteroureterostomia. Bladder injuries from trauma or surgery can be intraperitoneal or extraper
The document provides information about the anatomy, blood supply, innervation and functions of the urinary bladder. It discusses the location of the bladder in the pelvis. It describes the parts of the bladder including the body, fundus, neck, apex and surfaces. It explains micturition and various factors involved in bladder filling and emptying. The document also discusses bladder injuries including risk factors, signs, management and repair techniques. It provides details about vesicovaginal fistula including causes, types, presentations and approaches to repair.
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.
The document discusses various types of genitourinary trauma including renal trauma, bladder injuries, urethral injuries, testicular injuries, and penile fracture. Renal trauma is classified into 5 grades based on the severity of injury and most blunt renal traumas are managed conservatively. Bladder injuries are diagnosed using cystograms and managed either with catheter drainage or operative repair depending on the injury. Urethral injuries can involve the anterior or posterior urethra and are treated with suprapubic cystostomy or urethroplasty. Testicular injuries require early exploration and surgery if ruptured. Penile fractures require prompt surgical repair to prevent complications.
This document discusses genito urinary tract trauma. It describes different mechanisms of trauma including penetrating injuries, blunt trauma from acceleration/deceleration or rotational forces, and blast, chemical or thermal injuries. For renal trauma, it defines grades 1 through 5 for injuries ranging from minor to major. Clinical presentations include flank pain, abdominal pain, hematuria and distension. Investigations include blood tests, urine tests, imaging like ultrasound, IVU and CT scan. Complications of renal trauma can include urinoma, hematoma, abscess, hydronephrosis and arteriovenous fistula. Treatment depends on the type and severity of injury, and may involve emergency stabilization, observation, or surgery to address complications.
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.
Urethral stricture is a narrowing of the urethra caused by inflammation or scarring that results in difficult or painful urination. It can be caused by injuries, medical procedures, infections, or birth defects. Symptoms include bloody or dark urine, difficulty urinating, and pelvic or abdominal pain. Risks include infections of the bladder, prostate, or kidneys. Treatments may include dilation to widen the urethra, surgery to remove or bypass the stricture, or stents or catheters to keep the urethra open.
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
A urethral stricture is a narrowing of the urethra caused by scarring that can develop from infections, injuries, or other trauma. Men are more susceptible to urethral strictures since their urethras are longer. Common causes include sexually transmitted diseases, catheterization, or other instrumentation of the urethra. Symptoms include a slow or weak urine stream, pain while urinating, and blood in the urine. Diagnosis involves imaging tests of the urethra. Treatment options depend on the severity and location of the stricture, and may include gradual stretching through dilation, cutting the scar tissue, or surgical reconstruction of the urethra.
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.
This document summarizes a case of rhabdomyolysis likely caused by a drug interaction between simvastatin 80mg and gemfibrozil. The patient presented with progressive weakness and muscle pain. Labs showed a CPK over 20,000 and acute kidney injury. Rhabdomyolysis was diagnosed. The document then provides background on rhabdomyolysis including causes, pathogenesis involving calcium dysregulation and cell injury, systemic effects especially risk of acute kidney injury, diagnosis, and treatment options including IV fluids and bicarbonate to prevent pigment nephropathy. Close monitoring is needed due to risk of complications.
Management of traumatic liver injuries can be either operative or non-operative. Non-operative management is now the standard of care for hemodynamically stable patients with blunt hepatic trauma. Complications may occur in 12-14% of non-operatively managed patients and include re-bleeding, biliary complications, abscesses, and thromboembolic diseases. Operative management is indicated for hemodynamically unstable patients or those with severe injuries requiring surgery. Temporary control of hemorrhage during surgery can be achieved through manual compression, perihepatic packing, or the Pringle maneuver.
Urethral strictures can be traumatic, inflammatory, or neoplastic in nature. Inflammatory strictures are usually located in the proximal bulbar urethra and are caused by infections like gonorrhea or chlamydia. Traumatic strictures occur after catheterization or surgery and are commonly found in the posterior urethra. Both inflammatory and traumatic strictures can be multiple, vary in length, and lead to complications such as fistulas or pseudodiverticula if left untreated.
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.
This document discusses peripheral vascular injuries. Some key points:
- Peripheral injuries account for 80% of vascular trauma cases, with the lower extremities most commonly involved.
- Combined arterial and skeletal injuries in the extremities significantly increase the risk of limb loss compared to isolated injuries.
- Diagnosing and managing vascular injuries is technically challenging, as the physiology of trauma patients is complex. Damage control techniques like shunting and ligation may be necessary.
- Hard signs of vascular injury include active bleeding, pulsatile hematoma, limb ischemia. Soft signs require further investigation like Doppler or angiography to diagnose injury.
- Surgical management involves gaining proximal and distal control, investigating the injury site, and
This document discusses extremity vascular injuries, which can result in limb loss or death if not properly treated. The most common causes are road traffic injuries. Clinical features include signs of active bleeding, ischemia, pain, pallor, and pulse absence. Imaging like duplex scans and angiography can help diagnose the injury. Early surgical repair of damaged blood vessels is needed to restore blood flow. Complications include compartment syndrome, which requires fasciotomy to reduce pressure. Close monitoring is also needed after reperfusion to watch for systemic effects. With proper emergency treatment and surgery, many extremities can be saved from amputation.
extremity vascular injury, arterial injury, causes of arterial injury, mechanisms of arterial injury, investigations for arterial injury, treatment of arterial injury, , extremity vascular injuryfor medical students
This document summarizes the assessment and treatment of vascular trauma. It discusses the history of vascular surgery, mechanisms of injury, initial assessment and treatment focusing on controlling bleeding and ischemia. Signs of arterial injury are outlined. Surgical management may involve angiography, open exploration, repair, bypass or ligation. Compartment syndrome is a risk and location of injury impacts outcomes. Treatment of venous and carotid trauma is also addressed.
1. Renal trauma is most commonly caused by blunt injuries in children and accounts for 60% of genitourinary injuries, with 90% being blunt trauma.
2. Children are more susceptible to major renal injuries than adults due to smaller kidney size and location, less perirenal fat and weaker abdominal muscles.
3. Indications for imaging renal trauma in children include hematuria, abdominal injuries, or rapid deceleration events; CT is preferred for staging injuries while ultrasound is reliable for screening.
1. Abdominal trauma is commonly encountered in emergency departments and can be life-threatening. Blunt and penetrating injuries can cause damage to solid organs like the spleen, liver, and pancreas.
2. A thorough primary and secondary survey is essential to identify injuries. Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy help evaluate injuries. Conservative management is appropriate for many mild organ injuries.
3. Splenic injuries require close monitoring or surgery depending on grade. Liver injuries often stop bleeding spontaneously but may require packing or resection. Pancreatic injuries are difficult to diagnose and usually repaired surgically. Proper identification and treatment of abdominal injuries is critical for patient outcomes.
1) Abdominal trauma is commonly encountered and can be life-threatening. Identification of serious intra-abdominal injuries can be challenging.
2) Motor vehicle accidents account for 60% of abdominal trauma, with blunt trauma more common than penetrating injuries.
3) Injuries to solid organs like the spleen, liver, and kidneys require careful assessment and may be graded based on severity. Conservative management is often attempted initially if the patient is stable.
4) Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy can help identify injuries, but repeated examinations are often necessary. Management may involve surgery or conservative approaches depending on injury severity and patient stability.
abdominal trauma and renal trauma injury.pptxAkramChalid1
1. Renal trauma accounts for 1-5% of all traumas, with blunt trauma making up 90-95% of cases.
2. Initial assessment involves stabilizing the patient and evaluating for signs of renal injury like hematuria.
3. CT scan is the best way to diagnose and stage renal injuries in stable patients, while unstable patients may require IVP.
4. Non-operative management is recommended for most renal injuries. Operative management is considered for grade V injuries or hemodynamic instability.
Abdominal trauma can be life-threatening and identification of injuries is challenging. Blunt and penetrating trauma are the main causes. Pre-hospital care focuses on rapid transport to a trauma center. Initial assessment involves ABCDE protocol and secondary survey looks for occult injuries. Examinations like FAST, X-rays, USG, CT scan, and diagnostic laparoscopy help identify injuries. Common injuries include spleen, liver, pancreas, kidney, diaphragm, stomach, and blood vessels. Management depends on injury but may involve conservative treatment, surgery, or organ resection.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Octo...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Traumatic Abdominal Hernia
- Hemorrhagic Ovarian Cysts
- Small Bowel Obstruction
- Aortic Thrombus
This document summarizes guidelines for diverticulitis and recent updates. It discusses that the prevalence of diverticulosis is increasing compared to past centuries. About 20% of patients with diverticulosis will develop diverticulitis in their lifetime. For initial evaluation of acute diverticulitis, CT scan is the imaging of choice. Medical treatment typically involves antibiotics and diet modification. The decision to perform elective surgery after acute uncomplicated diverticulitis should be individualized. Emergency surgery is required for patients with diffuse peritonitis or treatment failure with non-operative management.
Assessment of Infra vesical obstruction.pptxFaisalHassanin
This document discusses infravesical obstruction, its assessment, and urodynamic studies. It begins by defining different types of obstruction and explaining how to initially assess obstruction based on symptoms, exam findings, and imaging. It then discusses the morbidity of urodynamic studies and their prognostic value. Guidelines on when to perform urodynamics are presented. A new concept of measuring isovolumetric bladder pressure noninvasively is proposed and initial pilot study results comparing invasive and noninvasive measurements are presented. The document concludes by discussing further studies needed to evaluate detrusor muscle reserve in a noninvasive manner.
Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction - clinical outcome and quality of life: a bi-center prospective study
Urology Journal Club
An intravenous pyelogram (IVP) uses iodinated contrast injected intravenously and x-ray imaging to evaluate the kidneys, ureters, and bladder. It is used to detect abnormalities, tumors, stones, or other issues. Patients fast before the procedure and are monitored after for side effects from the contrast such as nausea. Nursing care focuses on hydration, monitoring the IV site, and reporting any issues.
This document discusses catheterization, including appropriate indications, insertion techniques, complications, and prevention of catheter-associated urinary tract infections (CAUTIs). The key points are:
1) Catheters should only be used for approved indications and removed as soon as possible to prevent CAUTIs.
2) CAUTIs are the most common healthcare-associated infection and have significant costs and patient impacts.
3) Biofilm formation on catheters is a major mechanism of CAUTI development. Strict aseptic insertion and maintenance techniques can reduce risk.
1. Renal trauma accounts for 1-5% of all traumas, with blunt trauma making up 90-95% of cases. Physical exam findings like hematuria or flank pain may indicate renal injury.
2. Non-operative management is recommended for most renal injuries. Stable patients with Grade I-IV injuries can be managed conservatively with bed rest, hydration, antibiotics and monitoring.
3. Computed tomography is the best imaging method for diagnosing and staging renal injuries in stable patients. Unstable patients may require angiography or intravenous pyelography.
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 the grading and management of kidney and liver injuries. It outlines the American Association for the Surgery of Trauma (AAST) grading scales for kidney and liver injuries from Grade I to Grade V. For kidneys, Grade I injuries are superficial hematomas or lacerations less than 1 cm, while Grade V injuries involve complete destruction of the kidney. For livers, Grade I injuries are small hematomas or lacerations, while Grade V injuries disrupt over 75% of the hepatic lobe. Most kidney and liver injuries can be managed non-operatively with monitoring for stable patients. Surgery is indicated for hemodynamic instability or injuries involving major blood vessels.
1) Abdominal trauma is commonly encountered and can be life-threatening if not properly identified and treated. Blunt trauma is more difficult to diagnose than penetrating trauma.
2) The spleen and liver are the most commonly injured solid organs from blunt trauma, while the small intestine is most commonly injured hollow organ. Gunshot wounds most often injure the small bowel, colon, and liver.
3) Initial assessment and resuscitation of abdominal trauma follows ATLS protocols, while further workup may include FAST ultrasound, CT scan, diagnostic peritoneal lavage, and possible exploratory laparoscopy or laparotomy depending on findings and hemodynamic stability.
Abdominal trauma can cause serious injuries that are often difficult to diagnose. A thorough secondary survey including physical exam, lab tests, and imaging studies like FAST, CT scan, and diagnostic laparoscopy is needed to identify injuries. Common injuries include spleen laceration, liver laceration, small bowel perforation, and blunt trauma to solid organs. Management depends on injury severity but may involve conservative treatment, organ resection, or repair of damaged structures. Proper identification of intra-abdominal injuries is critical for developing an effective treatment plan.
CK17 is a basal/myoepithelial cell keratin that is induced in activated keratinocytes and associated with disease progression in squamous cell carcinomas. The study examines CK17 expression in anal squamous cell carcinomas, basaloid squamous cell carcinomas, pure basaloid carcinomas, and anal intraepithelial neoplasia. The results show that 100% of invasive squamous cell carcinomas and basaloid squamous cell carcinomas exhibited diffuse CK17 staining. Diffuse CK17 staining was also seen in the majority of basaloid squamous cell carcinomas and anal intraepithelial neoplasia grades 3/high grade dysplasia. However, the two cases of pure
This document summarizes information about intrahepatic duct (IHD) stones. IHD stones are most common in East Asia and can cause abdominal pain or jaundice. Treatment aims to completely remove stones and prevent further attacks. For difficult bilateral stones, percutaneous transhepatic cholangioscopy with lithotripsy can be used to clear sectors over multiple procedures. Hepatectomy may be indicated for unilateral disease, strictures, atrophy or suspected cancer. Recurrence rates are high but choledochoscopic laser lithotripsy combined with surgery achieved 93.3% stone clearance in one study, higher than conventional methods. Complete clearance with drainage restoration is needed to minimize recurrence.
This document discusses the use of oxidized regenerated cellulose (ORC) in breast reconstruction surgery. It summarizes the results of a study of 1004 patients who underwent oncoplastic procedures using ORC to improve cosmetic outcomes. ORC was found to reduce seroma formation and the need for repeated fluid aspiration after surgery. A small number of patients experienced allergic reactions. Ultrasound scans found small hyperechoic formations in the breast tissue of some patients, which were non-mobile, avascular and adhered to surrounding tissue. ORC is proposed to act as a filler, modulate tissue repair factors, and induce fibrosis to provide a permanent filler effect in breast reconstruction.
This document summarizes three cases of hand masses and provides information on common benign and malignant hand tumors. Case I describes a 77-year-old man with a firm mass on his third finger. Case II describes a 55-year-old woman with a cystic mass on her third finger. Case III describes a 43-year-old woman referred for a firm mass on her third finger. The document then reviews common benign tumors like ganglion cysts, giant cell tumors, and epidermal inclusion cysts. It also discusses malignant tumors such as squamous cell carcinoma, basal cell carcinoma, melanoma, and bone tumors including enchondroma and chondrosarcoma. Diagnostic workup and treatment options are provided
This medical document summarizes the case of a 21-year-old woman involved in a motorcycle crash. She was initially treated at an outside hospital before being transferred. Key findings included subcutaneous emphysema, shock, and deformities of the right forearm and left thigh. Imaging revealed potential injuries to the trachea, major blood vessels, and hollow organs. Her management involved further investigation and treatment of these injuries.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
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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.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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.
2. Reference
• Micheal Coburn . Genitourinary Trauma. in: K.L Mattox, D.V Feliciano, E.E
Moore ( Eds.) Trauma. 4th edition. McGraw-Hill Companies, New York;
2012:1583–1602.
• Holevar M, Ebert J, Luchette F, et al. Practical Management Guidelines for The
Management of Genitourinary Trauma. The EAST Practice Management
Guidelines Work Group. 2004.
• Morey AF, Brandes S, Dugi DD 3rd et al. Urotrauma: AUA guideline. J Urol
2014; 192: 327–35
• Summerton DJ, Djakovic N, Kitrey ND et al. Guidelines on Urological Trauma,
March 2015. Available at: http://uroweb.org/guideline/urologicaltrauma/.
Accessed November 2015
• Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma
guidelines. BJU Int. 2015.
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
4. Incidence
• KL Mattox. Trauma 4th edition. 2012
• 2-5% of all trauma patients
• 10% of abdominal trauma patients
• AUA guideline. 2014
• 1-5% of all trauma patients
• 4.9 injuries/100,000 population in the U.S.
• Kidney injury is most common
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
5. Incidence
• EAU guideline. 2015
• Kidney most genitourinary system injuried organ, Ureteral
trauma is rare.
• 5% of all trauma patients
• 10% of abdominal trauma patients
• Traumatic bladder injury mostly due to blunt injury
• Anterior urethra is most common by blunt or “fall-astride”
• Posterior urethra is usually injured in pelvic fracture cases
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
8. Renal Trauma
• Epidemiology, aetiology and pathophysiology:
• 1-5% trauma cases
• Most common injury in genitourinary organ
• Male > female (3:1)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
9. Renal Trauma
• Epidemiology, aetiology and pathophysiology:
• 75% age < 44 yrs
• Related with male
• 1.3-5% of blunt mechanism injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
AUA 2014
10. Renal Trauma
• Epidemiology, aetiology and pathophysiology:
• 82-95% blunt mechanism & ~70% MVC
(AUA 2014)
• > 80% blunt mechanism (BJU
international 2015)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
12. • 9% no haematuria in stab wounds and renal injury.
• 3-10% false negative in urine dipstick for haematuria.
Renal Trauma
• Lab investigation:
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
13. Renal Trauma
• Lab investigation:
• UPJ and renal pedicle injuries
• 80-94% have haematuria (BJU international 2015)
• 20-25% no haematuria (AUA 2014)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• Microscopic haematuria does not warrant imaging. (Grade
B, AUA 2014)
14. Renal Trauma
• Investigation:
• CT whole abdomen + IV contrast
• Standard; Grade B
• Stable patient + gross hematuria
• SBP < 90 mmHg + microscopic hematuria
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
AUA 2014
15. Renal Trauma
• Investigation:
• CT whole abdomen + IV contrast
• Recommendation; Grade C for Stable patient + concerning Hx or PE
• Rapid deceleration
• Significant blow to flank
• Lower rib fracture
• Significant flank ecchymosis
• Penetrating injury of abdomen, flank, or lower chest
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
AUA 2014
17. Renal Trauma
• Investigation:
• USG as FAST; sensitivity 48%
• Contrast enhanced USG; sensitivity 69%
• CT + IV contrast; sensitivity > 90%
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
• CT + IV contrast
18. Renal Trauma
• Investigation:
• Intravenous pyelography (IVP)
• Recommended only when it is the only
modality available.
• Sensitivity > 92%
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
19. Renal Trauma
• Investigation:
• One-shot intravenous pyelography (IVP)
• Rearly used
• Careful intraoperative palpation of the kidneys is
enough.
• Used when suspected single kidney (abnormal
size and consistency of contralateral kidney)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
Trauma, Mattox 7th ed
20. Renal Trauma
• Investigation:
• One-shot intravenous pyelography (IVP) before
retroperitoneal exploration in unstable patient:
• Recommendation; Grade C
• Exclude life-threatening renal injury
• Confirm the existence of a contralateral
functioning kidney
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
AUA 2014
21. Renal Trauma
• One-shot intravenous pyelography (IVP)
technique:
• A bolus intravenous injection of 2 mL/kg of
radiographic contrast
• A single plain film taken after 10 minutes
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
Trauma, Mattox 7th ed, AUA 2014, EAU 2015
22. T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
AUA 2014
Renal Trauma: Grading
• Grade I, II >> Low grade
• Grade > II >> High grade
Trauma, Mattox 7th ed
• Grade III, IV, V subgroup
Low risk : a
High risk: b
-Perirenal hematoma rim
distance > 3.5 cm
-Active intravascular contrast
extravasation
-A medial renal laceration site
23. • Conservative Rx
• Bed rest
• Serial Hct
• Repeat CT???
• Angioembolization
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
Renal Trauma
Modalities of Rx
• Surgical exploration
• Renorrhaphy
• Partial nephrectomy
>> non vital fragment
• Nephrectomy
• Repaired
renovascular injury
24. Renal Trauma
Conservative Mx
• AUA 2014:
• Clinicians should use non-invasive
management strategies in
hemodynamically stable patients
with renal injury. (Standard;
Evidence Strength: Grade B
• The surgical team must perform
immediate intervention (surgery or
angioembolization in selected
situations) in hemodynamically
unstable patients with no or
transient response to resuscitation.
(Standard; Evidence Strength:
Grade B)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• EAU 2015:
• Following blunt renal trauma,
stable patients should be
managed conservatively with
close monitoring of vital signs.
(Standard; Evidence Strength:
Grade B)
• Isolated grade 1-3 stab and
low-velocity gunshot wounds in
stable patients, after complete
staging, should be managed
expectantly. (Standard;
Evidence Strength: Grade B)
Conservative Rx in stable patients
25. Renal Trauma
Conservative Mx
• AUA 2014:
• Grade 1,2 and 3 (injuries
without hemodynamic
instability or devitalized
fragments) >>no need repeat
CT
• Grade 3 with hemodynamic
instability or devitalised
fragments, 4 and 5 >> repeat
CT at 36-72 hrs
(Recommendation; Evidence
Strength: Grade C)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• EAU 2015:
• Grade 1-4 asymptomatic >>
no need repeat CT
• Grade 4b and 5 >> repeat CT
at 48-72 hrs
• Symptomatic cases of fever,
flank pain, or falling
haematocrit >> urgent repeat
CT
(Standard; Evidence Strength:
Grade B)
26. Renal Trauma
Angioembolization
• AUA 2014:
• It should be the initial
treatment for patients
with persistent bleeding
lesions as:
• Grades 3 & 4
lacerations
• Arteriovenous fistula
• Pseudoaneurysmwith persistent bleeding
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• EAU 2015:
• It’s indicated in patients with
active bleeding from renal
injury, but without other
indications for immediate
abdominal operation.
(Standard; Evidence
Strength: Grade B)
• It’s the first-line option in the
absence of other indications
for immediate open surgery.
and vascular fistulae
27. Renal Trauma
Angioembolization
• AUA 2014:
• It should be the initial
treatment for patients with
persistent bleeding lesions
as:
• Grades 3 & 4 lacerations
with active extravasation
• Arteriovenous fistula
• Pseudoaneurysm
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• EAU 2015:
• Main indications
• Active haemorrhage
• Pseudoaneurysm
• Vascular fistulae
28. Renal Trauma
Operative indication
• AUA 2014:
• Absolute indication:
• Life threatening
hemorrhage believed to
be from renal injury
• Renal pedicle avulsion
• Expanding, pulsatile or
uncontained
retroperitoneal hematoma
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• EAU 2015:
• Indications for renal exploration:
• Haemodynamic instability
• Exploration for associated
injuries
• Expanding or pulsatile peri-renal
haematoma identified during
laparotomy
• Grade 5 vascular injury
(Standard; Evidence Strength:
Grade B)
29. Renal Trauma
Operative indication
• AUA 2014:
• Relative indication:
• Incomplete radiographic
staging with concurrent
traumatic injuries that
require repair/exploration
• extensive devitalized
renal parenchyma,
vascular injury and
urinary extravasation.
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• EAU 2015:
• Indications for renal exploration:
• Haemodynamic instability
• Exploration for associated
injuries
• Expanding or pulsatile peri-renal
haematoma identified during
laparotomy
• Grade 5 vascular injury
(Standard; Evidence Strength:
Grade B)
33. Renovascular Injury
• AUA and EAU:
• Conservative Rx
• Angioembolization in unstable cases
• Repaired in solitary kidney or bilateral injury
• Explor for other injuries situation
• Repaired in early warm ischemic time (20-30 mins)
• Nephrectomy in hilar injury with prolonged warm ischemic
time
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
34. • Renal reconstruction should be attempted once
haemorrhage is controlled (Grade B, EAU).
• The benefit of prior vascular control is
inconclusive (Grade B, AUA).
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
Operative Renal Trauma
Mx
35. • Renorrhaphy is most common operation.
• Nephrectomy in exploration only 13%.
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
Operative Renal Trauma
Mx
EAU 2015
37. Renal Trauma
Complication
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• AUA 2014:
• Urinary drainage in the presence
of complications such as
enlarging urinoma, fever,
increasing pain, ileus, fistula or
infection. (Recommendation;
Evidence Strength: Grade C)
• Ureteral stent drainage should
be achieved and may be
augmented by percutaneous
urinoma drain, percutaneous
nephrostomy or both. (Expert
Opinion)
• EAU 2015:
• Persistent urinary extravasation from
an otherwise viable kidney after blunt
trauma often responds to stent
placement and/or percutaneous
drainage as necessary.
• Delayed retroperitoneal bleeding may
be life-threatening and selective
angiographic embolisation is the
preferred treatment.
• Perinephric abscess formation is best
managed by percutaneous drainage,
although open drainage may
sometimes be required.
38. Ureteral Trauma
• Epidemiology, aetiology and pathophysiology:
• 1-2.5% of urinary trauma cases
• 2-3% GSW abdominal injury
• Most common injury in upper ureter (deceleration mechanism)
• Blunt injury related with severe abdominal and pelvic injuries.
• Penetrating injury related with vascular and intestinal injuries.
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
AUA 2014, EAU 2015
39. Ureteral Trauma
Diagnosis
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• AUA 2014:
• High index of suspicious.
• Clinicians should perform IV contrast
enhanced abdominal/pelvic CT with
delayed imaging (urogram) for stable
trauma patients with suspected
ureteral injuries. (Recommendation;
Evidence Strength: Grade C)
• Clinicians should directly inspect the
ureters during laparotomy in patients
with suspected ureteral injury who
have not had preoperative imaging.
(Clinical Principle)
• EAU 2015:
• High index of suspicious.
• Extravasation of contrast medium
in computerised tomography (CT)
is the hallmark sign of ureteral
trauma.
• In unclear cases,a retrograde or
antegrade urography >> gold
standard for confirmation.
• IVP esp. one-shot IVP >>
unreliable in diagnosis (false
negative rate 60%).
41. Ureteral Trauma
Management
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• AUA 2014:
• Repair traumatic ureteral lacerations
at the time of laparotomy in stable
patients. (Recommendation;
Evidence Strength: Grade C)
• Temporary urinary drainage followed
by delayed definitive management of
ureteral injuries in unstable patients
(Clinical Principle)
• Manage traumatic ureteral contusions
at the time of laparotomy with ureteral
stenting or resection and primary
repair depending on ureteral viability
and clinical scenario. (Expert
Opinion)
• EAU 2015:
• Immediate repair of ureteral injury
is usually advisable in stable
patients.
• Unstable trauma patients, a
‘damage control’ approach is
preferred with ligation of the ureter,
diversion of the urine (e.g. by a
nephrostomy), and a delayed
definitive repair.
• Perinephric abscess formation is
best managed by percutaneous
drainage, although open drainage
may sometimes be required.
Stable >> repaired
Unstable >> Damage control with
temporary urinary diversion
42. Ureteral Trauma
Reconstructive Option
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• AUA 2014: (Recommendation; Evidence Strength:
Grade C)
• Ureteral injuries located distal
to the iliac vessels
• Ureteral reimplantation
• Primary repair over a
ureteral stent, when
possible.
• Ureteral injuries located
proximal to the iliac vessels
• Primary repair over a
ureteral stent, when
possible.
44. Bladder Trauma
• Epidemiology, aetiology and pathophysiology:
• Most common blunt injury. (mostly motor vehicle
accident)
• 60-90% associated with pelvic fracture. (but only 3.6% in
pelvic fracture cases)
• 44% have at least one other intra-abdominal injury
• Extraperitoneal > intraperitoneal > combined
• 4.1-15% combined with urethral injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
45. • 60% extraperitoneal type
• 30% intraperitoneal type
• 10% combined type
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
BJU 2015
Bladder Trauma: Grading
46. Bladder Trauma
Diagnosis
• 77-100% haematuria (AUA 2014), Cardinal sign of bladder injury
(EAU 2015)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• AUA 2014:
• Perform retrograde cystography (plain
film or CT) in stable patients with
gross hematuria and pelvic fracture.
(Standard; Evidence Strength: Grade
B)
• Perform retrograde cystography in
stable patients with gross hematuria
and a mechanism concerning for
bladder injury, or in those with pelvic
ring fractures and clinical indicators of
bladder rupture. (Recommendation;
Evidence Strength: Grade C)with persistent bleeding
• EAU 2015:
• Cystography is the preferred
diagnostic modality for non-
iatrogenic bladder injuries, and in
suspected,iatrogenic, post-
operative, bladder injuries.
(Standard; Evidence Strength:
Grade B)
• Cystography (conventional or CT
imaging) is required in the
presence of visible haematuria
and pelvic fracture. (Standard;
Evidence Strength: Grade B)
• Retrograde Cystography is best modality for Dx
(Sent 90-95%, Spec 100%)
• Used in hematuria with clinical suspected injury as
pelvic fracture
47. • Cystography must be performed using retrograde filling of the
bladder with a minimum volume of 350 mL of dilute contrast
material.
• Intraperitoneal bladder injury:
• Intraperitoneal extravasation
• Free contrast medium is visualised in the abdomen, highlighting
bowel loops and/or outlining abdominal viscera such as the
liver.
• Extraperitoneal bladder injury: flame-shaped areas of contrast
extravasation in the perivesical soft tissues
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
Retrograde Cystography
EAU 2015
48. Bladder Trauma
Treatment
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• Surgical exploration and repair
• Surgeons must perform surgical
repair of intraperitoneal bladder
rupture in the setting of blunt or
penetrating external trauma. (AUA
2014, Standard; Evidence
Strength: Grade B)
• Intraperitoneal bladder ruptures by
blunt trauma, and any type of
bladder injury by penetrating
trauma, must be managed by
emergency surgical exploration
and repair. (EAU 2015, Standard;
Evidence Strength: Grade B)
• Conservative treatment
• Clinicians should perform
catheter drainage as treatment
for patients with uncomplicated
extraperitoneal bladder
injuries. (AUA 2014,
Recommendation; Evidence
Strength: Grade C)
Intrapertioneal
bladder injury
in any mechanism
49. Bladder Trauma
Treatment
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• Surgical exploration and repair
• Surgeons should perform surgical
repair in patients with complicated
extraperitoneal bladder injury.
(AUA 2014, Recommendation;
Evidence Strength: Grade C)
• Complicated:
• Bladder neck involvement
• Bone fragments in the bladder
wall
• Concomitant rectal injury or
entrapment of the bladder wall
• Conservative treatment
• Clinicians should perform catheter
drainage as treatment for patients
with uncomplicated extraperitoneal
bladder injuries. (AUA 2014,
Recommendation; Evidence
Strength: Grade C)
• In the absence of bladder neck
involvement and/or associated
injuries that require surgical
intervention, extraperitoneal bladder
ruptures caused by blunt trauma
are managed conservative. (EAU
2015, Standard; Evidence Strength:
Grade B)
50. Sx Technique
Bladder Injury
• Two-layer vesicorraphy (mucosa-detrusor) with
absorbable sutures. (EAU 2015)
• Clinicians should perform urethral catheter
drainage without suprapubic (SP) cystostomy in
patients following surgical repair of bladder
injuries. (AUA 2014, Standard; Evidence Strength:
Grade B)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
51. Bladder Trauma
Follow Up
• Conservative Rx
• Planned 1st cystography at 7-14 day post injury.
• Operative repair
• Simple injury: removed cath in 7-10 days without a
cystography
• Complex injury (trigone involvement, ureteric
reimplantation) or in the case of risk factors of wound
healing >> control cystography
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
52. Urethral Trauma
• Epidemiology, aetiology and pathophysiology:
• Rare in female
• In male classify into anterior & posterior urethral
injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
53. Urethral Injury
• Mechanism
• Blunt
• Penetrating
• Location
• Anterior urethral injury
• Posterior urethral injury
• Lesion
• Partial rupture
• Complete rupture
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
54. Urethral Trauma
• Anterior urethral injury:
• Most blunt mechanism (‘straddle injuries’ or
kicks in the perineum)
• Bulba urethra most common
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
56. Urethral Trauma
• Posterior urethral injury:
• 72% related with pelvic fracture
• Classify into partial VS complete rupture
• Risk of urethral injury in type of pelvic fracture
• Straddle fractures with a concomitant diastasis
of the sacroiliac joint > straddle fractures alone
> Malgaigne fractures
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
58. Urethral Trauma
• Posterior urethral injury:
• 45% found erectile dysfunction (ED) with strong predictors
factor
• Diastasis of the pubic symphysis
• Lateral displacement of the prostate
• A long urethral gap (> 2 cm)
• A bilateral pubic rami fracture
• A Malgaigne’s fracture
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
59. Urethral Trauma
Diagnosis
• Signs:
• Blood at meatus >> cardinal sign
• Inability to void >> suspected complete rupture
• ***Rectal exam*** >> 5% associated rectal injury in male (EUA
2015)
• ‘High riding’ prostate >> unreliable finding
• ***Vaginal exam*** >> associated vaginal injury in female
• Difficulty or inability to pass urethral catheter
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
Grade C, AUA 2014
60. • EAU 2015:
• Retrograde urethrography is
the gold standard for evaluating
urethral injuries. (Standard;
Evidence Strength: Grade B)
Urethral Trauma
Investigation for Diagnosis
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• AUA 2014:
• Clinicians should perform
retrograde urethrography in
patients with blood at the
urethral meatus after pelvic
trauma. (Recommendation;
Evidence Strength: Grade C)
Retrograde urethrography
is
investigation of choice
61. Penetrating
Anterior Urethral Injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• AUA 2014:
• Surgeons should perform
prompt surgical repair in
patients with uncomplicated
penetrating trauma of the
anterior urethra. (Expert
Opinion)
• EAU 2015:
• Immediate exploration is
advised, except when this is
precluded by other life-
threatening injuries.
62. Blunt
Anterior Urethral Injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• AUA 2014:
• Clinicians should establish
prompt urinary drainage in
patients with straddle injury to
the anterior urethra.
(Recommendation; Evidence
Strength: Grade C)
• EAU 2015:
• Blunt anterior urethral injuries
should be treated by
suprapubic diversion.
(Recommendation; Evidence
Strength: Grade C)
63. Penetrating
Posterior Urethral Injury
• Management dependent on
• Associated injuries:
With VS without rectal injury
• Clinical condition of the patient:
stable VS unstable
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
64. Penetrating
Posterior Urethral Injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
• Clinical:
• Unstable >> suprapubic
diversion with delayed
abdominoperineal urethroplasty
• Stable >> immediate
exploration by the retropubic
route and primary repair or
realignment
• Rectal injury:
• With rectal injury >> Diverting
colostomy
65. Blunt
Posterior Urethral Injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
• Immediate urinary diversion
consider :
• To monitor urinary output
(haemodynamic condition and
the renal function)
• To treat symptomatic retention
(conscious patient)
• To minimise urinary
extravasation (its secondary
effects, such as infection and
fibrosis)
• Urinary diversion:
• Suprapubic catheter should be
placed under US guidance
and direct vision.
66. Blunt
Posterior Urethral Injury
• Clinicians should establish prompt urinary drainage in patients with
pelvic fracture associated urethral injury. (Recommendation; Evidence
Strength: Grade C)
• Surgeons may place suprapubic tubes (SPTs) in patients undergoing
open reduction internal fixation (ORIF) for pelvic fracture. (Expert
Opinion)
• Clinicians may perform primary realignment (PR) in hemodynamically
stable patients with pelvic fracture associated urethral injury. (Option;
Evidence Strength: Grade C)
• Clinicians should not perform prolonged attempts at endoscopic
realignment in patients with pelvic fracture associated urethral injury.
(Clinical Principle)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
AUA 2014
67. Blunt Partial
Posterior Urethral Injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
• Follow up:
• 2 wks urethrography
• Complication:
• Residual or subsequent
stricture
• Internal urethrotomy: short
and non-obliterative
• Anastomotic urethroplasty:
long and dense, complete
obliteration, failed internal
urethrotomy
68. Blunt Complete
Posterior Urethral Injury
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
EAU 2015
• Standard treatment:
• Deferred treatment
• 3 mths suprapubic diversion
• Deferred urethroplasty at a
minimum 3 mths after : a
one-stage perineal approach
• Surgical > endoscopic
• Alternative treatment: ***Need
experienced hand***
• Acute definitive treatment (<48
hrs after injury)
• Delayed primary treatment (2
days - 2 wks after injury)
69. Blunt Complete
Posterior Urethral Injury
Alternative treatment
• Delayed primary treatment
(2 days - 2 wks after injury)
• Immediate realignment:
apposition of the urethral
ends over a catheter
(endoscopic method)
• Immediate urethroplasty:
suturing of urethral ends
• Not affect rate of
subsequent stricture
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• Benefits:
• Lower stricture rate
• Simplified scarring and subsequent
stricture
• Easier future uretheroplasty
• Bleeding better resolved
• Limitation:
• Stable
• Short defect
• Enable lithotomy position
70. Blunt Complete
Posterior Urethral Injury
Alternative treatment
• Acute definitive treatment
(<48 hrs after injury)
• Associated with bladder
neck or rectal injury
• Immediate realignment:
apposition of the urethral
ends over a catheter
(endoscopic method)
• Immediate urethroplasty:
suturing of urethral ends
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
• Benefits:
• Lower stricture rate
• Simplified scarring and
subsequent stricture
• Easier future uretheroplasty
• Risks:
• Uncontrolled bleeding
• Extensive unjustified tissue
debridement
71. Urethral Injury
Follow Up
• Clinicians should monitor patients for
complications (e.g., stricture formation, erectile
dysfunction, incontinence) for at least one year
following urethral injury. (Recommendation;
Evidence Strength: Grade C)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
AUA 2014
74. Summary
• Kidney:
• CT + IV contrast
• Mostly conservative Rx
• Operative Mx as indicated (mostly renorrhaphy)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
75. Summary
• Ureter:
• CT + IV contrast + Delayed phase (urogram)
• Stable patient >> repair
• Unstable patient >> demage control + diversion
• Lesion above iliac vessel >> repaired over stent
• Lesion below iliac vessel >> reimplant
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
76. Summary
• Bladder:
• Retrograde cystography
• Extraperitoneal type: mostly conservative Rx
• Intraperitoneal type: Surgical repair
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T
77. Summary
• Urethra:
• Retrograde urethrography
• Penetrating urethral injury >> surgical repair
• Blunt anterior urethral injury >> Urinary drainage
(prefered SPC)
• Blunt posterior urethral injury
• Partial >> urinary drainage (Prefered SPC) 2 wks
• Complete >> deferred treatment (SPC 3mth +
deferred surgical urethroplasty)
T
R
A
U
M
A
&
B
U
R
N
U
N
I
T