Genito-Urinary Trauma

Firtantyo Adi Syahputra

Background
Trauma is the 6th leading cause of death
worldwide 10% of all mortalities
5 million deaths each year worldwide
and causes disability
Death from injury is twice as common in
males as females, especially from motor
vehicle accidents (MVA) and
interpersonal violence.
1.
2.

Soreide K, et al Br J Surg 2009

Middleton P, et al Oxford 2010

Background Genito-Urinary Trauma

Is seen in up to 5% of all trauma cases and
10% of all abdominal cases
Renal direct impact, frontal crashes (seatbelt /
steering wheel)
Ureter (1-2.5%) iatrogenic, penetrating gunshot
wounds
Bladder associated with pelvic fracture
Posterior Urethra associated with pelvic fracture
Anterior Urethra fall-astride trauma

Genital physical sports, violence, warfighting

1.
2.

Soreide K, et al Br J Surg 2009

Middleton P, et al Oxford 2010

Initial evaluation and treatment

1.

Wutzler S, et al. J Am Coll Surg 2009

Blunt Renal Trauma

Haematuria
Flank Pain
Abdominal Distention
Abdominal mass
Abdominal tenderness

Renal Trauma

Algorithm of Blunt
Renal Trauma

Algorithm of Penetrating
Renal Trauma

Ureteral Trauma

Signs of delayed diagnosis:

Flank pain, urinary incontinence,
vaginal/drain urinary leackage,
haematuria, fever

Principles of Surgical Repair

Bladder Trauma
Sign
Gross Hematuria (Cardinal Sign)
Abdominal tenderness
Inability to void
Bruises over the suprapubic region
Abdominal distention

1.
2.
3.

Wirth GJ, et al. BJU Int 2010

Tonkin JB et al. Med Clin North Am 2011
Rodder K, et al. Urologe A 2005.

Bladder Trauma
Intraperitoneal
Ruptures
Sudden rise in
intravesical
pressure
Bladder dome is
the weakest point
and the most
mobile

Extraperitoneal
Ruptures
Associated with
pelvic fractures
Distortion of the
pelvic ring,
counter-coup
Perforated by a
bony fragment

Bladder Trauma
Cystography
Non-iatrogenic and post-operative setting
Retrograde filling of bladder with 350 mL
of dilute contrast
Passive bladder filling during the
excretory phase is insufficient

Cystoscopy
Intra-operative setting

Bladder Trauma
Extraperitoneal
Catheter drainage
Except for: bladder neck involvement or
surgical for other associated injuries

Intraperitoneal bladder ruptures OR

penetrating bladder injury
mandatory managed by emergency
surgical exploration and repair
Two-layer vesicorraphy (mucosadetrusor) with absorbable sutures

Urethra
Clinical Signs:
Blood at the meatus
Blood at he vaginal introitus
Haematuria
Pain on urination
Haematoma
Swelling
High-riding or absent prostate

Management of Anterior Urethral Injuries

Management of Posterior Urethral Injuries

Flow Diagram Iatrogenic Urethral Injury Caused

by improper insertion of catheter

Thank You