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Managing acute urological trauma

Managing acute urological trauma. Mungai Ngugi. Genitourinary injuries (GUI). can lead to significant morbidity and mortality, incidence , severity and optimal treatment of these injuries has not been establishedin population-based cross-sectional studies

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Managing acute urological trauma

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  1. Managing acute urological trauma Mungai Ngugi

  2. Genitourinary injuries (GUI) • can lead to significant morbidity and mortality, • incidence, severity and • optimal treatment of these injuries has not been establishedinpopulation-based cross-sectional studies • Renal injury (RI) occurs in approximately 1–5% of all traumas Baverstock R, Simons R, McLoughlin M. Severe blunt renal trauma: a 7-year retrospective review from a provincial trauma centre. Can J Urol 2001;8:1372.

  3. kidney is the most commonly injured genitourinary and abdominal organ • Blunt trauma accounts for the largest percentage of RIs (90–95%) • Penetrating injuries -more severe, higher number of associated organ injuries, and result in a higher nephrectomy rate (25–33%)

  4. AAST organ injury severity scale for the kidney • 1 Contusion or non-expanding subcapsularhaematoma. No laceration • 2 Non-expanding perirenalhaematoma cortical laceration <1 cm deep without extravasation • 3 Cortical laceration >1 cm without urinary extravasation • 4 Laceration: through corticomedullary junction into collecting system • Or Vascular: segmental renal artery or vein injury with contained haematoma • 5 Laceration: shattered kidney • Or Vascular: renal pedicle injury or avulsion The Committee on Organ Injury Scaling of the American Association for the Surgery of Trauma (AAST)

  5. Kidney and ureter • history of falls, • high-speed motor vehicle accidents, • direct blow to the flank • Pre-existing renal abnormality makes RI more likely following trauma • Haematuria • CT is the gold standard method for the radiographic assessment of stable patients with RIs

  6. Kidney and ureter • Absolute indications for surgery include life threatening renal haemorrhagehaemodynamic instability • trauma to the ureter is relatively rare and accounts for only 1% of all GUI • 75% are iatrogenic

  7. Knh 2011 and 2012

  8. bladder • 2%abdominal injuries that require surgical • repair, involve the bladder • Blunt trauma accounts for 67–86% of bladder ruptures (BR), while • penetrating trauma for 14–33% • The most common cause (90%) of BR by blunt trauma is motor vehicle accidents

  9. Urethral trauma • Anterior urethra • Posterior urethra

  10. Management • Index of suspision • Imaging • Emergency surgery • Elective surgery

  11. treatment • Kidney Most except penetrating managed conservatively • Ureter • Surgical treatment • Urethra spc then definitive repair

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