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Presentation on theme: "INJURIES TO THE GENITOURINARY TRACT"— Presentation transcript:


2 Special examination A.Catheterization and assessment of injury
2-CT scan 3-retrograde cystography 4-urethrography 5-arteriography 6-IVP B.Cystoscopy and retrograde urography C.Abdominal sonography

3 Injuries to the kidney Etiology
-most common injuries of urinary system -kidney with existing pathologic condition are more readily ruptured Etiology -Blunt trauma(80-85%) -Penetrating truma to the flank area should be regarded as a cause of renal injury until proved otherwise -Associated abdomial visceral injuries are present in 80% of renal penetrating wounds

4 Pathology & classification
A-early pathologic finding 1)-grade I (the most common)renal contusion microscopic hematuria 2)-grade II renal parenchymal laceration perirenal hematoma 3)-grade III laceration extending into the renal medulla large retroperitoneal hematoma 4)-grade IV laceration extending into the renal collecting system-artry injuries 5)-grade V multiple gIV –renal pedicle avulsion main renal artery or vein from penetrating trauma

5 Pathology & classification (continue)
B-late pathologic findings 1-urinoma 2-hydronephrosis 3-arteriovenous fistula 4-ranal vascular hypertension

6 Treatment A.Emergency measures B.Surgical measures 1)Blunt inguries
85% no operation require operation indicated in: -persitent retroperitoneal bleeding -Urinary extravasation -non viable parenchyma -renal pedicle injuries

7 Treatment(continue) 2)Penetrating injuries exploration is needed rare exception:minor parenchymal injury with no U. extravasation in 80% of cases:associated organ injury

8 Treatment(continue) C.Treatment of complications:
urinoma & abscass:drainage malignant hypertention:vascular repair or nephrectomy hydronephrosis:surgical correction or nephrectomy

9 prognosis -excellent prognosis -IVP & BP monitoring is needed

10 Injuries to the ureter Etiology: Clinical finding: Lab exam:hematuria.
-iatrogenic:tul-pelvic surgery -deceleration accident:avulse the ureter Clinical finding: -signs & symptoms:fever- flank pain-nausea & vomiting-urinary leakage (within first 10 postoperative days).ileus Lab exam:hematuria.

11 Imaging IVP-retrograde ureterography-spiral CT: extravasation
hydronephrosis Sonography:hydronephrosis-urinoma Radionuclide examining:delayed excretion accumulation in renal pelvis

12 Differential diagnosis
Bowel obstruction deep wound infection Peritonitis acute pyelonephritis Fever

13 Treatment The best opportunity:in the operating room- until 7-10 days
Lower ureteral injuries:reimplantation-ureteroureterostomy-bladder tube flap-trans- ureteroureterostomy Midureteral injuries:ureteroureterostomy or trans u. ureteostomy Upper ureteral injuries:ureteroureterostomy-auto transplantation-bowel replacement Stenting Prognosis:excellent

14 Injuries to the bladder
Usually due to external force Often associated with perlvic fracture(15% of pelvic fractures) iatrogenic injury

15 Clinical findings Pelvic fracture : crepitus-painful
Unable to urinate- Hematuria Hemorrhagic shock D.R.E.: distinct landmarks

16 Lab:Hematuria X-ray:pelvic fracture-extravasation Complications:pelvic abscess-peritonitis-incontinency(partial)

17 Treatment Extraperitoneal:foley cath (bladderneck injury-large bloodclots→surgical management) Intraperitoneal:surgical repair Prognosis :excellent

18 Inguries to the urethra
Clinical findings:lower abdominal pain-inability to urinate-blood at the uretheral meatus-prostate displacement-perineal hematoma X-Ray findings:pelvic fracture-extravasation Complications:stricture-impotency-incontinency

19 Treatment Immediate management : cystostomy
Delayed urethral reconstruction urethroplasty. Immediate urethral realignment




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