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Urogenital Trauma
This document summarizes urogenital trauma, including the kidneys, ureters, bladder, and urethra. It notes that the kidneys are most commonly injured in blunt trauma from impacts with seatbelts or steering wheels. Bladder and posterior urethra injuries are often associated with pelvic fractures from blunt trauma. Evaluation of trauma involves examination for bruising, hematuria, and penetrating objects. Imaging like ultrasound, IVP, CT and cystography are used for diagnosis. Surgical management depends on the specific organ injured and degree of trauma.
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Urogenital Trauma
- 1. Anne Saputra by. GuidelinesUrological Trauma EAU 2015 UROGENITAL TRAUMA
- 2. ⦿ KIDNEY ->regulate blood volume and composition, regulate pH, hormones and excrete waste ⦿ URETERS -> Transport urine from kidney to bladder ⦿ BLADDER -> store urine and expels through urethra ⦿ URETHRA (Genitalia) -> discharge urine from the body
- 3. EPIDEMIOLOGY •Male > Female •Mostcommon injured: KIDNEY (seatbelt or steering wheel side impact crashes) •Rare : URETERAL (due to iatrogenic / penetrating gunshot) •CLASSIFICATION: Blunt and Penetrating •BLUNT : 1.Mostly BLADDER and posterior urethra (associated pelvic fracture) 2.Anterior urethra (fall-astride trauma) Summerton et al, 2015 Guidelines on Urological Trauma EAU
- 4. INITIAL EVALUATION •A-B-C-D-E •Blunt :Bruise / hematome flank-urogenital area •Penetrating : weapon in stabbing •HEMATURIA (minor/gross)
- 5. RENAL Jacobs, L.M., Luk,S.S., 2010. Advanced Trauma Operative Management. 2nd ed. CineMed. Canada.
- 6. Summerton et al,2015 Guidelines on Urological Trauma EAU
- 7. Summerton et al,2015 Guidelines on Urological Trauma EAU
- 8. DIAGNOSTIC 1. Physical examination 2.Laboratory -> CBC, UL, RFT 3. Imaging -> Ultrasound, IVP, One-shot intraoperative, CT, MRI
- 10. ` Mc.Aninch JW; Surgeryfor Renal Trauma. in Novick AC. Stewart’s Operative Urology. Baltimore. Williams&Wilkins Urology. 1989:234-9
- 11. URETER • Incidence :mostly IATROGENIC (gynaecological, colorectal, ureteroscopy and radical prostatectomy) Summerton et al, 2015 Guidelines on Urological Trauma EAU
- 14. Zaid, U.B, etal. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep 1:119-124
- 15. Jacobs, L.M., Luk,S.S., 2010. Advanced Trauma Operative Management. 2nd ed. CineMed. Canada.
- 16. BLADDER Classified : 1. Contusion 2.Rupture : Intraperitoneal (20%) and Extraperitoneal (80%) Mostly -> BLUNT trauma (85% occur pelvic fractures)
- 18. Sign Symptoms Summerton etal, 2015 Guidelines on Urological Trauma EAU
- 19. • Zaid, U.B,et al. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep 1:119-124
- 20.
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- 22. URETHRAL Summerton et al,2015 Guidelines on Urological Trauma EAU
- 24. • Zaid, U.B,et al. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep 1:119-124
- 25.
- 28. Management 1. PARTIAL TEAR-> careful passage of 12-14Fr. foley, if any resistance : UROLOGY 2. COMPLETE TEAR : UROLOGY + Suprapubic cath 3. If Foley already there and suspect tear : LEAVE Foley in a place *Initial urethral repair is not recommended, because of risk hemorrhage, impotence and risk of pelvic infection hematoma
- 30. REFFERENCE • Jacobs, L.M.,Luk, S.S., 2010. Advanced Trauma Operative Management. 2nd ed. CineMed. Canada. • Mattox, et al. 2013. Trauma. 7th ed. Mc Graw Hill. New York. • Mc.Aninch JW; Surgery for Renal Trauma. in Novick, A.C., Streem, S.B., Pontes, J.E.. Stewart’s Operative Urology. Baltimore. Williams & Wilkins Urology. 1989:234-9 • Metro J.M., Mc Aninch, J.W., 2003. Surgical Exploration of the injured kidney: Current Indications and Techniques. Int bras urol. vol.29 no.2 Rio de Janiero. • Skandalakis L.J., 2014. Surgical Anatomy and Technique. 4th ed. Springer. New York • Summerton et al, 2015 Guidelines on Urological Trauma EAU • Williams, N.S., Bulstrode, C.J., 2008. Bailey & Love’s Short Practice of Surgery. 25th ed. Hodder Arnold. Great Britain • Zaid, U.B, et al. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep 1:119-124 • Zollinger, R.M., Ellison, E.C., 2011. Atlas of Surgical Operations. 9th ed. Mc Graw Hill. New York.
- 31.
Editor's Notes
- #4 From epidemiology, genitourinary trauma is significant source of death and morbidity which the ratio male > female Most common injured organ: Kidney and ureteral are less common injured From the classification, there is blunt and penetrating trauma. which penetrating trauma, typically need surgical explorations.
- #6 Renal injury grading based on AAST 2010, there is 5 grade from mild to severe grading Contussion, non expanding sub capsular hematome Cortical laceration less 1cm deep Cortical laceration more 1cm, WITHOUT urine extravacasion Laseration on corticomedular Shatered kidney (pedicle avulsion)
- #7 This is flowchart of blunt renal trauma from EAU Guidelines 2015
- #10 This is CT Scan Abdominal, the red arrow showed pedicle shattered of the left renal
- #11 Surgical management: Rhenorrhapy, to closure of pelvic vein ligation
- #12 Anatomical Ureter divided by: Upper (Proximal): At Lumbosacral border Middle : parallel to the Sacral bone Lower (Distal): High psoas muscle
- #21 Intraperitoneal: Contrast enters the intraperitoneal cavity and outlines loops of bowel Extrapritoneal: Contrast extravasates from the bladder into the premedical space