GENITOURINARY TRAUMA

kidney Mechanisms of Injury 1.Blunt renal trauma accidents, falls, crush 2.Penetrating trauma gunshot, stab

kidney Classification of Injury 1.Simple laceration 2.Subcapsular hematoma 3.Renal contusion 4.Renal rupture 5.Laceration of renal artery and vein 6.Perirenal hematoma 7.Laceration through collecting system

Classification of Injury

kidney Diagnosis 1.History 2.Presentation Shock, hematuria, pain 3.Physical examination Mass

kidney Diagnosis 4.Urinalysis gross hematuria,microscopic hematuria The degree of hematuria may not predict the severity of renal injury. 5.X-ray examination KUB Intravenous pyelogram (IVU) Arteriography

kidney Diagnosis 6. Computed tomography(CT) 7. Ultrasonography 8. Radionuclide scans

kidney Treatment 1.Observation Blood pressure,pulse,breathe,urine, hemachrome keep the bed 3-4 weeks

kidney Treatment 2. Renal exploration Indication: Uncontrolled bleeding Renovascular injury Nonviable parenchyma Major urinary extravasation

Ureter Causes 1. Injury 2. Surgery 3. Endoscopy 4. Radiolgy therapy

Ureter Presentation: 1. History 2. Urine leak 3. Infection 4. Aurina 5. Hematuria 6. Obstruction

Ureter Diagnosis 1. History 2. Intravenous pyelogram (IVU) 3. Retrograde pyelogram

Ureter Treatment 1. One-stage repair during the initial evaluation of a trauma 2. External drainage for 3 months if injury above 24h.

Bladder Classification and Mechanism of Injury 1.Causes Blunt trauma, penetrating trauma Endoscopy 2.Site Extraperitoneal Rupture Intrapritoneal Rupture Combined Rupture

Site of bladder injure

Bladder Diagnosis 1. History 2. Catheterization examination 3. Cystography

Bladder Treatment 1. Intrapritoneal Rupture Surgical exploration and repair 2. Extraperitoneal Rupture Surgical exploration and repair or Catheterization 3. Anti-infection

Urethra Causes 1. Endo-urethra injury endosocopy 2. Exterior-urethra injury pelvis-fracture

Urethra Site 1. Posterior urethra prostatic and membranous injuries above or including the urogenital diaphragm 2. Anterior urethra injuries of the bulbous and penile urethra

Anatomise of urethra

Injury of anterior urethra

Injury of posterior urethra

Urethra Pathology 1. Sprian 2. Cracking 3. Rupture Stage: 1. Trauma period 2. Inflammation period 3. Structure period

Urethra Presentation 1. Shock 2. Bleeding 3. Pain 4. Void unsuccessful and Rentention 5. Haematoma 6. Urine leak

Urethra Diagnosis 1. History 2. Physical examination digital rectal examination 3. Catheter insert 4. Retrograde urethrography

Urethra Treatment 1. Anti-infection and prevent shock 2. Main urethral successive 3. Drainage urine of bladder 4. Drainage urine leak

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