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Liping Xie

Urogenital Trauma. Liping Xie. Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University. Urogenital Trauma. Renal & Ureteral Injury Bladder Injury Urethral Injury Injuries of the external genitalia.

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Liping Xie

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  1. Urogenital Trauma Liping Xie Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University

  2. Urogenital Trauma • Renal & Ureteral Injury • Bladder Injury • Urethral Injury • Injuries of the external genitalia Three to 10% of trauma patients have GU involvement; 10-15% of trauma patients with abdominal injuries have GU involvement.

  3. Renal Injury

  4. Renal Injury • Renal injuries constitute 45% of all GU injuries; • Most renal injuries (80%) are minor and do not require surgical intervention; • Renal trauma can happen in both blunt or penetrating trauma; • Renal injuries are most commonly from motor vehicle accidents (MVAs);

  5. Renal Injury Scale

  6. Renal Injury Physicalexamination: • Flank ecchymosis or mass indicates a retroperitoneal process but is not specific to renal injuries and rarely occurs acutely. • The most important indicator of renal trauma is gross or microscopic hematuria. • The absence of hematuria, although rare, does not exclude renal injury because it is absent in 5% of patients.

  7. Renal Injury Radiographic Staging • IVP - double dose • CT Scan - best method of staging - radiographic study of choice • Ultrasound • Angiography - used for suspected renovascular injury

  8. Left renal laceration CT Staging for Renal Injury Right renal stab wound (Grade IV)

  9. Management of Renal Injury

  10. Surgical Management for Renal Injury

  11. Ureteral Injury

  12. Ureteral Injury • Ureteral injuries after external violence are rare, occurring in less than 4% of cases of penetrating trauma and less than 1% cases of blunt trauma. • Ureteral injuries after external violence, unlike renal injuries, are difficult to detect with the usual array of diagnostic tools.

  13. Ureteral Injury Excretory urography demonstrating extravasation in the upper right ureter consequent to stab wound (Arrow)

  14. Surgical Management for Ureteral Injury

  15. Bladder Injury • Bladder injuries classified into contusions, extraperitoneal and intraperitoneal ruptures ; Intraperitoneal (20%) Extraperitoneal (80%) Rupture A full bladder is more likely to become injured than an empty one.

  16. Bladder Injury • mostly occur in blunt trauma. Eighty-five percent of these injuries occur with pelvic fractures; • 15% occur with penetrating trauma and blunt mechanism without a pelvic fracture (ie, full bladder blowout). • gross hematuria in the trauma setting requires imaging of both upper and lower urinary tract

  17. Bladder Injury

  18. Diagnosis Cystogram and CT are helpful diagnostic tools. Cystogram (left) shows extraperitoneal bladder rupture with extravasation into scrotum. CT(right) reveals intraperitoneal bladder rupture with contrast material surrounding bowel loops

  19. Surgical Mangement of Bladder Rupture

  20. Urethra Injury

  21. Urethra Injury • Almost exclusively in male • Most common in straddle injure • Significant morbidity • Stricture • Incontinence • Impotence • Foley catheter implication

  22. Urethra Injury • Gross hematuria in 98% • Inability to void • Blood at urethral meatus • Pelvic / suprapubic tenderness • Penile / scrotal / perineal hematoma • Boggy / high-riding prostate/ ill-defined mass on rectal examination. Posterior Urethra- Anterior Urethra- • More common than posterior • Direct trauma • Usually NO pelvic injury • Blood at meatus • Unable to micturate • Penile/Scrotal/Perineal • Contusion • Hematoma • Fluid collection

  23. Urethra Injury High Riding Prostate on DRE EXTRAVASATION OF URINE

  24. Diagnosis Urethrogram is the best diagnostic tool-

  25. Urethrogram

  26. Urethrogram Contrast extravasation + Contrast in bladder Contrast extravasation only PARTIAL Tear COMPLETE Tear

  27. Urethrogram retrograde urethrography via meatus Extravasation of contrast medium with the “missing” bladder indicates a complete tear of the urethra

  28. Management of Urethral Injury • Partial tear • careful passage of 12-14 Fr. Foley. • If any resistance: Urology • Complete tear: • Urology + suprapubic cath. • If Foley already there and suspect tear: • LEAVE FOLEY IN PLACE Initial urethral repair is not recommended because of risk of hemorrhage, impotence, and infection of pelvic hematoma.

  29. Management of Urethral Injury Surgical Repair Bank’s Method

  30. Injuries of the external genitalia • Penis • Penetrating, skin avulsion and amputation repaired surgically • “fracture” repaired and drained surgically • Scrotum/testes • Hematocele and contusion (mild) or rupture (severe, needs exploration) • Penetrating injuries need exploration

  31. Injuries of the external genitalia scrotal hematoma after straddle injure Penile fracture

  32. Thanks

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