urinary tract trauma

5/26/2018 Urinary Tract Trauma

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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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urinary tract trauma

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