GENITOURINARY TRAUMA

kidney

Mechanisms of Injury

1.Blunt renal trauma

accidents, falls, crush

2.Penetrating trauma

gunshot, stab

kidney

Classification of Injury1.Simple laceration2.Subcapsular hematoma 3.Renal contusion 4.Renal rupture5.Laceration of renal artery and vein6.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

Thank you!