Injuries to the Genitourinary TractDr. Kaveh Mehravaran

Urologist, Fellowship of Endourology & Laparoscopy

Hasheminejad Hospital

About 10% of all injuries seen in the emergency room involve the genitourinary system to some extent.

The history should include a detailed description of the Accident

The abdomen and genitalia should be examined for evidence of contusions or subcutaneous hematomas, which might indicate deeper injuries to the retroperitoneum and pelvic structures.

Fractures of the lower ribs are often associated with renal injuries, and pelvic fractures often accompany bladder and urethral injuries.

Special Examinations

Catheterization

Computed tomography

Retrograde cystography

Urethrography

Arteriography

Intravenous urography

CYSTOSCOPY

ABDOMINAL SONOGRAPHY

INJURIES TO THE KIDNEY

Renal injuries are the most common injuries of the urinary system.

Kidneys with existing pathologic conditions such as hydronephrosis or malignant tumors are more readily ruptured from mild trauma.

Blunt trauma directly to the abdomen, flank, or back is the most common mechanism, accounting for 80–85% of all renal injuries.

LATE PATHOLOGIC FINDINGS

Urinoma

Hydronephrosis

Arteriovenous fistula

Renal vascular hypertension

Treatment

EMERGENCY MEASURES

Blunt injuries:Cases in which operation is indicated include those associated with persistent retroperitoneal bleeding, urinary extravasation, evidence of nonviable renal parenchyma, and renal pedicle injuries

Penetrating injuries

TREATMENT OF COMPLICATIONS

INJURIES TO THE URETER

Etiology

SYMPTOMS

SIGNS

LABORATORY FINDINGS

IMAGING FINDINGS

Treatment

The best opportunity for successful repair is in the operating room when the injury occurs.

If the injury is not recognized until 7–10 days after the event and no infection, abscess, or other complications exist, immediate reexploration and repair are indicated.

Proximal urinary drainage by percutaneous nephrostomy or formal nephrostomy should be consideredif the injury is recognized late or if the patient has significant complications that make immediate reconstruction unsatisfactory.

INJURIES TO THE BLADDER

Bladder injuries occur most often from external force and are often associated with pelvic fractures. (About 15% of all pelvic fractures are associated with concomitant bladder or urethral injuries.

SYMPTOMS

SIGNS

Treatment

Extraperitoneal bladder rupture

Intraperitoneal rupture

INJURIES TO THE URETHRAINJURIES TO THE POSTERIOR URETHRA Etiology

SYMPTOMS

SIGNS

X-RAY FINDINGS

INSTRUMENTAL EXAMINATION

Treatment

Immediate management

Delayed urethral reconstruction

Immediate urethral realignment

INJURIES TO THE ANTERIOR URETHRA

Etiology

SYMPTOMS

SIGNS

X-RAY FINDINGS

Treatment

Urethral contusion

Urethral lacerations

Urethral laceration with extensive urinary extravasation

Immediate repair

INJURIES TO THE PENIS

INJURIES TO THE SCROTUM

INJURIES TO THE TESTIS

TORSION

Obstructive uropathy