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Urinary Tract Trauma
Iwan Asmara A
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Urinary Tract Trauma
Is an emergency condition
Need immediate management
Early diagnosis is important to preventcomplication
Usually associated with other organ injuries :
Brain Abdominal organs
Bone fracture
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Renal Trauma
Most common
Etiology :
1.
Blunt Trauma Traffic Accident
Falling from Height
Sport injuries, Fight
2. Penetrating Trauma Stab wound
Gunshot wounds
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Figure 6-1. Classification of renal injury: Grade I, renal contusion and subcapsularhematoma; Grade II, cortical laceration and perirenal hematoma; Grade III, deepparenchyma: laceration through corticomedullary junction and segmental renal arterythrombosis without a parenchymal laceration: Grade IV, laceration involving thecollecting system, with or without a devascularized segment and contained vascular
injury Grade V, renal artery thrombosis. avulsion of the renal pedicle, and shatteredkidney.
Renal Trauma
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DIAGNOSIS
A. History of Illness : Hystory of Trauma Mechanic
B. Clinical Sign :
General Status General condition Pale, sign of shock Associated injury :
Central Nervous System Thorax Abdominal Fracture
Renal Trauma
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Urological Status
Flank :-Hematom, Wound
-Mass / Bulging
-Tenderness
Hematuria
- Microscopic-Macroscopic
C. Laboratory
-Hb, Ht
-UrinalysisHematuria
D. Radiology
- KUB -IVU
- CTScan
-Arteriography
Renal Trauma
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Schema of Renal Trauma
Renal Trauma
Shock (+)
Resuscitation
Shok (+) Shock (-)
Operation
Shock(-)
KUB - IVU
Not Informative N Extravasations
CT-scan
Operation
Observation
Arteriography
Operation
N
Renal Trauma
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Therapy
Resuscitation
Conservative Operative :
Repair
Nephrectomy
Renal Trauma
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Ureteral Trauma
Rare
Etiology :
Iatrogenic : Pelvic operation
Gynecology
Endoscopy
Penetrating (Stab/gunshot) trauma
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Injury ligation, rupture, cutting
Clinical Symptoms Flank pain caused of acute hydronephrosis
Fever
Ileal Paralytic
If bilateral : anuria, uremia
Fistel : uretero-vaginal, ureterocutaneus
Peritonitis
Laboratory :urinalysis, ureum, creatinine
Radiology :
- KUB
IVU- RPG
- Ultrasonography
Ureteral Trauma
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Therapy
Distal ureter : Uretero-ureterostomy
Implantation to the bladder
Middle ureter : Uretero-ureterostomy
Trans-uretero-ureterostomy
Proximal ureter :
Uretero-ureterostomy Nephrectomy
Autotransplantation
Ureteral Trauma
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Bladder Trauma
Etiology IatrogenicGynecology operation, endoscopy
Trauma Pelvic fracture extraperitoneal
ruptureFull bladder intraperitoneal rupture
Clinical Symptoms History of Trauma
Sign, suprapubic hematom / pubic Haematuria
Peritonitis.
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Laboratory
Urinalysis : haematuria
Radiology
Pelvic Photo Fracture
Cystography
Therapy
Repair
Bladder Trauma
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Urethral Trauma
Anterior Urethral Trauma
Position : Distal from urogenital diagphram
Etiology :
Straddle Injury Instrumentation
Clinical Signs :
Blood from urethral meatus
Hematom, perineal pain Urinary retenstion
Radiology : urethrogram
Therapy : immediate repair
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Anterior Urethral Trauma
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Posterior Urethral Trauma
Etiology Pelvic bone fracture
Clinical Symptoms Blood from meatus Urinary retention Pain, hematom on pubic region
Radiology Pelvic Photo Urethrogram
Therapy Sistostomy Repair 3-4 days later.
P i U h l T
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Posterior Urethral Trauma
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