Urinary Tract Trauma

Iwan Asmara A

Urinary Tract Trauma

Is an emergency condition Need immediate management Early diagnosis is important to prevent complication Usually associated with other organ injuries :

Brain Abdominal organs Bone fracture

Renal Trauma

Most common Etiology :

1.

Blunt Trauma

Traffic Accident Falling from Height Sport injuries, Fight Stab wound Gunshot wounds

2.

Penetrating Trauma

Renal Trauma

Figure 6-1. Classification of renal injury: Grade I, renal contusion and subcapsular hematoma; Grade II, cortical laceration and perirenal hematoma; Grade III, deep parenchyma: laceration through corticomedullary junction and segmental renal artery thrombosis without a parenchymal laceration: Grade IV, laceration involving the collecting system, with or without a devascularized segment and contained vascular injury Grade V, renal artery thrombosis. avulsion of the renal pedicle, and shattered kidney.

Renal Trauma

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

Urological Status Flank :

- Hematom, Wound - Mass / Bulging - Tenderness

Hematuria
- Microscopic - Macroscopic

C. Laboratory
- Hb, Ht - Urinalysis Hematuria

D. Radiology
- KUB -IVU - CT Scan - Arteriography

Renal Trauma

Schema of Renal Trauma

Renal Trauma

Shock (+)

Shock(-)

Resuscitation KUB - IVU Shok (+) Shock (-) Not Informative Operation CT-scan N N Observation Operation Operation Arteriography Extravasations

Renal Trauma

Therapy

Resuscitation Conservative Operative :

Repair Nephrectomy

Ureteral Trauma

Rare Etiology :

Iatrogenic :

Pelvic operation Gynecology Endoscopy

Penetrating (Stab/gunshot) trauma

Ureteral Trauma

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

Therapy

Distal ureter :

Uretero-ureterostomy Implantation to the bladder

Uretero-ureterostomy Trans-uretero-ureterostomy Uretero-ureterostomy Nephrectomy Autotransplantation

Middle ureter :

Proximal ureter :

Bladder Trauma

Etiology

Iatrogenic Gynecology operation, endoscopy Trauma Pelvic fracture extraperitoneal rupture Full bladder intraperitoneal rupture
History of Trauma Sign, suprapubic hematom / pubic Haematuria Peritonitis.

Clinical Symptoms

Bladder Trauma

Laboratory

Urinalysis : haematuria Pelvic Photo Fracture Cystography Repair

Radiology

Therapy

Urethral Trauma
Anterior Urethral Trauma

Position : Distal from urogenital diagphram Etiology :

Straddle Injury Instrumentation Blood from urethral meatus Hematom, perineal pain Urinary retenstion

Clinical Signs :

Radiology : urethrogram Therapy : immediate repair

Anterior Urethral Trauma

Posterior Urethral Trauma

Etiology

Pelvic bone fracture Blood from meatus Urinary retention Pain, hematom on pubic region Pelvic Photo Urethrogram Sistostomy Repair 3-4 days later.

Clinical Symptoms

Radiology

Therapy

Posterior Urethral Trauma