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INJURIES TO THE GENITOURINARY TRACT

INJURIES TO THE GENITOURINARY TRACT. S.Vahidi. Special examination. A.Catheterization and assessment of injury 1-catheterization 2-CT scan 3-retrograde cystography 4-urethrography 5-arteriography 6-IVP B.Cystoscopy and retrograde urography C.Abdominal sonography.

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INJURIES TO THE GENITOURINARY TRACT

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  1. INJURIES TO THE GENITOURINARY TRACT S.Vahidi

  2. Special examination A.Catheterization and assessment of injury 1-catheterization 2-CT scan 3-retrograde cystography 4-urethrography 5-arteriography 6-IVP B.Cystoscopy and retrograde urography C.Abdominalsonography

  3. Injuries to the kidney -most common injuries of urinary system -kidney with existing pathologic condition are more readily ruptured Etiology -Blunt trauma(80-85%) -Penetrating truma to the flank area should be regarded as a cause of renal injury until proved otherwise -Associated abdomial visceral injuries are present in 80% of renal penetrating wounds

  4. Pathology & classification A-early pathologic finding 1)-grade I (the most common)renal contusion microscopic hematuria 2)-grade II renal parenchymal laceration perirenal hematoma 3)-grade III laceration extending into the renal medulla large retroperitoneal hematoma 4)-grade IV laceration extending into the renal collecting system-artry injuries 5)-grade V multiple gIV–renal pedicle avulsion main renal artery or vein from penetrating trauma

  5. Pathology & classification (continue) B-late pathologic findings 1-urinoma 2-hydronephrosis 3-arteriovenous fistula 4-ranal vascular hypertension

  6. Treatment A.Emergency measures B.Surgical measures 1)Blunt inguries 85% no operation require operation indicated in: -persitent retroperitoneal bleeding -Urinary extravasation -non viable parenchyma -renal pedicle injuries

  7. Treatment(continue) 2)Penetrating injuries exploration is needed rare exception:minor parenchymal injury with no U. extravasation in 80% of cases:associated organ injury

  8. Treatment(continue) C.Treatment of complications: urinoma & abscass:drainage malignant hypertention:vascular repair or nephrectomy hydronephrosis:surgical correction or nephrectomy

  9. prognosis -excellent prognosis -IVP & BP monitoring is needed

  10. Injuries to the ureter Etiology: -iatrogenic:tul-pelvic surgery -deceleration accident:avulse the ureter Clinical finding: -signs & symptoms:fever- flank pain-nausea & vomiting-urinary leakage (within first 10 postoperative days).ileus Lab exam:hematuria.

  11. Imaging • IVP-retrograde ureterography-spiral CT: extravasation hydronephrosis • Sonography:hydronephrosis-urinoma • Radionuclide examining:delayed excretion- accumulation in renal pelvis

  12. Differential diagnosis Bowel obstruction deep wound infection Peritonitis acute pyelonephritis Fever

  13. Treatment • The best opportunity:in the operating room- until 7-10 days • Lower ureteralinjuries:reimplantation-ureteroureterostomy-bladder tube flap-trans- ureteroureterostomy • Midureteralinjuries:ureteroureterostomy or trans u. ureteostomy • Upper ureteralinjuries:ureteroureterostomy-auto transplantation-bowel replacement • Stenting • Prognosis:excellent

  14. Injuries to the bladder • Usually due to external force • Often associated with perlvic fracture(15% of pelvic fractures) • iatrogenic injury

  15. Clinical findings • Pelvic fracture : crepitus-painful • Unable to urinate- Hematuria • Hemorrhagic shock • D.R.E.: distinct landmarks

  16. Lab:Hematuria X-ray:pelvic fracture-extravasation Complications:pelvic abscess-peritonitis-incontinency(partial)

  17. Treatment • Extraperitoneal:foley cath (bladderneck injury-large bloodclots→surgical management) • Intraperitoneal:surgical repair • Prognosis :excellent

  18. Inguries to the urethra Clinical findings:lower abdominal pain-inability to urinate-blood at the uretheral meatus-prostate displacement-perineal hematoma X-Ray findings:pelvic fracture-extravasation Complications:stricture-impotency-incontinency

  19. Treatment • Immediate management : cystostomy • Delayed urethral reconstruction urethroplasty. • Immediate urethral realignment

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