Trauma

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Trauma

  1. 1. Urology Department Under-graduate courses Genito-urinary TraumaBy Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  2. 2. For our Lectures and Scientific resourcesvisit our web sites, Uroainshams.blogspot.com Uronotes2012.blogspot.com ©
  3. 3. Renal trauma Epidemiology • Most common among genito-urinary trauma • 1-5 % of all trauma Mechanism: • Blunt trauma (motor car accidents, assaults, falls, contact sports) • Penetrating trauma (stabs, high velocity gunshots) • Blast effect (low velocity gunshots) ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  4. 4. Renal trauma- Classification – Grade I : Contusion or non expanding subcapsular hematoma (no laceration) – Grade II : Non expanding peri-renal hematoma or cortical laceration < 1 cm – Grade III : Cortical laceration > 1 cm – Grade IV : Laceration through cortico-medullary junction into collecting system or segmental artery or vein injury with contained hematoma – Grade V: Shattered kidney or renal pedicle injury or avulsion ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  5. 5. Renal trauma- Evaluation History of trauma: direct blow to the flank, rapid deceleration, type and size of weapon Signs indicating an underlying renal injury (fractured ribs, flank ecchymoses or abrasions). Physical examination and assessment of hemodynamic instability (heart rate, blood pressure, respiratory rate, and mental state). Urinalysis for detection of microscopic hematuria. (degree of hematuria does not correlate with of degree renal injury) Imaging CT with contrast or on- table IVU (single shot). ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  6. 6. Renal trauma- Management 1. Blunt injuries:  most of them are managed conservatively (90%).  Life threatening haemodynamic instability or grade 5 injuries are absolute indication for surgical exploration (10%). 2. Sharp injuries are managed by surgical exploration. • Most explorations ultimately lead to a nephrectomy. • The presence of a normal functioning kidney on the contralateral side must be established. ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  7. 7. Renal trauma- Complications Early complications Late complications – Bleeding – Hydronephrosis – Infection – Calculus formation – Abscess formation – Chronic pyelonephritis – Urinary fistula – Hypertension (Page – Urinoma kidney) – Arteriovenous fistula – Pseudoaneurysm ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  8. 8. Bladder injuries • Presentation: by Gross hematuria (82% of patients), along with lower abdominal tenderness. • Diagnosis: by cystogram Intraperitoneal injury: Extraperitoneal injury: contrast material outlines loops Dense, flame-shaped collection of bowel. of contrast material in the pelvis ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  9. 9. Bladder injuries- Management • Blunt extraperitoneal rupture managed by catheter drainage. Most ruptures heal within 10 days. • Penetrating or intraperitoneal injuries should be managed by immediate operative repair. ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  10. 10. Urethral injuries • Male urethra is divided by urogenital diaphragm into 2 segments: 1. Anterior (bulbar & penile) 2. Posterior (membranous & prostatic) ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  11. 11. Urethral injuries • Posterior urethral injuries mostly result from pelvic fractures. • The injury can range from a stretch or contusion injury to complete disruption. • Anterior urethral injuries occur after road traffic accidents, falls, or straddle type injuries (blunt blow to the perineum). • Iatrogenic injury to the urethra secondary to endoscopic trauma and instrumentation is the most common cause of urethral stricture. ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  12. 12. Urethral injuries- Diagnosis Blood at urethral meatus Ascending urethrography before trial of catheterization ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  13. 13. Urethral injuries- Management • Anterior urethral injury: – Initial management by suprapubic cystotomy. – Later, stricture formation can be managed with endoscopy (for short strictures) or urethroplasty (for longer strictures). • Posterior urethral injury: – a suprapubic catheter is placed and delayed repair (urethroplasty) is done after 3 months. ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  14. 14. Testicular injuries Classification: • Blunt: kicks, straddle injuries (compression fo the testicle against lower border of pubic bone). • Penetrating Testicular rupture Significant testicular injuries present with a swollen tender scrotum ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  15. 15. Testicular injuries management • Conservative treatment: in the absence of significant scrotal swelling. • Early scrotal exploration is needed in cases of testicular rupture (tunica albuginea tear). 1. Debridement of non-viable tissue is undertaken, with an attempt to preserve as much testicular tissue as possible. 2. orchidectomy is performed when the testicle cannot be conserved. ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  16. 16. Penile fracture Aetiology • Extreme angulation of erect penis during intercourse is the most common cause. • Classic history is diagnostic • Tear in the tunica may be palpated Classic presentation – Severe pain – Rapid detumescence – Penile swelling and echimosis as a result of rupture of the tunica albuginia that covers the corpora cavernosa. Management • Early repair of penile fracture maintains erectile function and prevents late onset penile curvature. ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  17. 17. Thank YouBy Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

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