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INJURIES TO THE GENITOURINARY TRACT S.Vahidi. Special examination A.Catheterization and assessment of injury 1-catheterization 2-CT scan 3-retrograde.

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Presentation on theme: "INJURIES TO THE GENITOURINARY TRACT S.Vahidi. Special examination A.Catheterization and assessment of injury 1-catheterization 2-CT scan 3-retrograde."— Presentation transcript:

1 INJURIES TO THE GENITOURINARY TRACT S.Vahidi

2 Special examination A.Catheterization and assessment of injury 1-catheterization 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 -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 g IV –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: -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 o IVP-retrograde ureterography-spiral CT: extravasation hydronephrosis o Sonography:hydronephrosis-urinoma o Radionuclide examining:delayed excretion- accumulation in renal pelvis

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

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

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

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

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

17 Treatment o Extraperitoneal: foley cath (bladderneck injury-large bloodclotssurgical management) o Intraperitoneal: surgical repair o 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 o Immediate management : cystostomy o Delayed urethral reconstruction urethroplasty. o Immediate urethral realignment

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