Urinary Tract Trauma By Pretoria Hoyte

Etiology  Any patient with a history of traumatic injury should be assessed for involvement of the urinary tract.  Trauma to the urinary tract often is associated with bladder trauma, or damage to the urethra, wounds to the lower abdomen, and anyone patient who has undergone abdominal surgery.

Bladder Injury  Injuries to the bladder can be divided into blunt trauma (such as a blow to the body) or penetrating wounds (such as bullet or stab wounds).  Because the bladder is located within the bony structures of the pelvis, it is protected from most external forces. Injury may occur if there is a blow to the pelvis that is severe enough to break the bones and cause bone fragments to penetrate the bladder wall.

Bladder injury due to pelvic fractures /

Urethral Damage  Urethrospasm (a spasm of the musculature of the urethra); urethrocutaneous fistula(a cutaneous fistula between the urethra and the skin) this occurs after repair of hypospadias or exstrophy of the bladder; urethrocele (which is a herniation of the urethra in females)

Herniation of the Urethra

Clinical Manifestations  Urine output should be monitored hourly for amount and color  Any evidence of hemauria should be reported  Pt. is assess for abdominal pain and tenderness (indicates hemorrhage, peritonitis)  Difficulty voiding, flank pain

Diagnostics  An IVP (a radiographic technique for examining the structure function of the urinary system) may be needed.  Urinalysis, KUB radiograph, excretory urogram, and

Diagnostics cont.  A cystoscopy may also be needed.

Medical Management  Surgical intervention will be necessary for correction of tears or rupture of the integrity of the urinary tract to reinstate urine flow  This can be done with the removal of the kidney or bladder, with the creation of urinary diversion.

Medical Management cont.  If the trauma is located in the kidney a nephrectomy (is the surgical removal of a kidney, performed to remove a tumor or otherwise diseased kidney) must be done.

Medical Management cont.  If the trauma occurs in the bladder a cystectomy (a surgical procedure in which all or part of the urinary bladder is removed) may be needed with urinary diversion.

Nursing Interventions  Nursing responsibility centers on identifying individuals at risk and detecting variations in assessment findings that indicate trauma to the urinary tract.

Prognosis  Prognosis depends on the extent and location of the trauma.