Presentation on theme: "Urogenital Trauma Liping Xie"— Presentation transcript:
1 Urogenital Trauma Liping Xie Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University
2 Urogenital Trauma Renal & Ureteral Injury Bladder Injury Three to 10% of trauma patients have GU involvement; 10-15% of trauma patients with abdominal injuries have GU involvement.Renal & Ureteral InjuryBladder InjuryUrethral InjuryInjuries of the external genitalia
4 Renal Injury Renal injuries constitute 45% of all GU injuries; Most renal injuries (80%) are minor and do not require surgical intervention;Renal trauma can happen in both blunt or penetrating trauma;Renal injuries are most commonly from motor vehicle accidents (MVAs);
6 Renal Injury Physical examination: Flank ecchymosis or mass indicates a retroperitoneal process but is not specific to renal injuries and rarely occurs acutely.The most important indicator of renal trauma is gross or microscopic hematuria.The absence of hematuria, although rare, does not exclude renal injury because it is absent in 5% of patients.
7 Renal Injury Radiographic Staging IVP - double dose CT Scan - best method of staging - radiographic study of choiceUltrasoundAngiography - used for suspected renovascular injury
8 CT Staging for Renal Injury Right renal stab wound (Grade IV)Left renal laceration
12 Ureteral InjuryUreteral injuries after external violence are rare, occurring in less than 4% of cases of penetrating trauma and less than 1% cases of blunt trauma.Ureteral injuries after external violence, unlike renal injuries, are difficult to detect with the usual array of diagnostic tools.
13 Ureteral InjuryExcretory urography demonstrating extravasation in the upper right ureter consequent to stab wound (Arrow)
15 A full bladder is more likely to become injured than an empty one. Bladder InjuryBladder injuries classified into contusions, extraperitoneal and intraperitoneal ruptures ;Intraperitoneal (20%)Extraperitoneal (80%)RuptureA full bladder is more likely to become injured than an empty one.
16 Bladder Injurymostly occur in blunt trauma. Eighty-five percent of these injuries occur with pelvic fractures;15% occur with penetrating trauma and blunt mechanism without a pelvic fracture (ie, full bladder blowout).gross hematuria in the trauma setting requires imaging of both upper and lower urinary tract
18 DiagnosisCystogram and CT are helpful diagnostic tools. Cystogram (left) shows extraperitoneal bladder rupture with extravasation into scrotum. CT(right) reveals intraperitoneal bladder rupture with contrast material surrounding bowel loops
21 Urethra Injury Almost exclusively in male Most common in straddle injureSignificant morbidityStrictureIncontinenceImpotenceFoley catheter implication
22 Urethra Injury Posterior Urethra- Anterior Urethra- Gross hematuria in 98%Inability to voidBlood at urethral meatusPelvic / suprapubic tendernessPenile / scrotal / perineal hematomaBoggy / high-riding prostate/ ill-defined mass on rectal examination.More common than posteriorDirect traumaUsually NO pelvic injuryBlood at meatusUnable to micturatePenile/Scrotal/PerinealContusionHematomaFluid collection
23 Urethra InjuryHigh Riding Prostate on DREEXTRAVASATION OF URINE
24 Urethrogram is the best diagnostic tool- DiagnosisUrethrogram is the best diagnostic tool-
27 retrograde urethrography via meatus Urethrogramretrograde urethrography via meatusExtravasation of contrast medium with the “missing” bladder indicates a complete tear of the urethra
28 Management of Urethral Injury Partial tearcareful passage of Fr. Foley.If any resistance: UrologyComplete tear:Urology + suprapubic cath.If Foley already there and suspect tear:LEAVE FOLEY IN PLACEInitial urethral repair is not recommended because of risk of hemorrhage, impotence, and infection of pelvic hematoma.
29 Management of Urethral Injury Surgical RepairBank’s Method
30 Injuries of the external genitalia PenisPenetrating, skin avulsion and amputation repaired surgically“fracture” repaired and drained surgicallyScrotum/testesHematocele and contusion (mild) or rupture (severe, needs exploration)Penetrating injuries need exploration
31 Injuries of the external genitalia scrotal hematoma after straddle injurePenile fracture
32 ThanksThis is our hospital building and you are welcome.