Lower Urinary Tract Trauma Dr Charles Chabert

Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder injury Combined urethra & bladder 15% BJU Int 2004, Vol 94, 27-32

Blunt trauma to distended bladder Bladder Trauma Contusion Intraperitoneal Rupture at dome Blunt trauma to distended bladder Extraperitoneal Pelvic fracture BJU Int 2004, Vol 94, 27-32

Bladder Trauma Management Cystogram / CT Cysto Intraperitoneal Extraperitoneal Surgical Closure Catheter Drainage BJU Int 2004, Vol 94, 27-32

Extraperitoneal Rupture

Intraperitoneal Rupture                               

Bladder Trauma Management Cystogram / CT Cysto Intraperitoneal Extraperitoneal Surgical Closure Catheter Drainage BJU Int 2004, Vol 94, 27-32

Catheter Drainage / Surgical Summary Extraperitoneal Cystogram Catheter Drainage / Surgical

Posterior Urethra Injuries 3-25% pelvic # 27% other injuries Rare in female Short, mobile lacks attachments Female 0-0.6%

Posterior Urethra Injuries Pelvic # Gunshot wounds Stab Wounds Iatrogenic Contusion Partial Complete with disruption

Posterior Urethra Injuries Blood at meatus Difficulty voiding Palpable bladder High riding prostate

Retrograde Urethrogram Evaluation Retrograde Urethrogram Posterior urethral Injury SPC Partial Complete SPC IDC Primary realignment

                                         

Retrograde Urethrogram Evaluation Retrograde Urethrogram Posterior urethral Injury SPC Partial Complete SPC IDC Primary realignment

Immediate / delayed Realignment Summary Pelvic # Urethrogram Immediate / delayed Realignment

Sexual intercourse related Penile fracture Corporal # Sexual intercourse related Cracking sound Rapid detumescence BJU Int 94;507-515

Penile fracture Clinical diagnosis Eggplant sign Meatal blood Surgical exploration BJU Int 94;507-515

Genital Skin Loss Avulsion Animal bites Self mutilation

Associated injuries with penetrating trauma 80% Scrotal Trauma 85% blunt trauma 15% penetrating Associated injuries with penetrating trauma 80% BJU Int 2004, 94; 507-515

Scrotal Trauma Management Penetrating / Blunt Scrotal Ultrasound Suspected rupture Tunica intact Supportive care Surgery BJU Int 2004, 94; 507-515

Supportive / exploration Summary Blunt Ultrasound Supportive / exploration