GENITOURINARY TRAUMA

kidney
Mechanisms of Injury

1.Blunt renal trauma

accidents, falls, crush

2.Penetrating trauma
gunshot, stab

kidney
Classification of Injury 1.Simple laceration 2.Subcapsular hematoma 3.Renal contusion 4.Renal rupture 5.Laceration of renal artery and vein 6.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
1.
2. 3. 4. 5.

6.

Presentation: History Urine leak Infection Aurina Hematuria 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
1. 2. 3. 1. 2. 3.

Pathology Sprian Cracking Rupture Stage: Trauma period Inflammation period 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!