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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
2. Penetrating Trauma
Stab wound
Gunshot wounds
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 (+)
Resuscitation
Shok (+) Shock (-)
Operation
Shock(-)
KUB - IVU
Not Informative N Extravasations
CT-scan
Operation
Observation
Arteriography
Operation
N
Renal Trauma
Therapy
Resuscitation
Conservative
Operative :
Repair
Nephrectomy

Renal Trauma
Ureteral Trauma
Rare
Etiology :
Iatrogenic :
Pelvic operation
Gynecology
Endoscopy
Penetrating (Stab/gunshot) 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
Middle ureter :
Uretero-ureterostomy
Trans-uretero-ureterostomy
Proximal ureter :
Uretero-ureterostomy
Nephrectomy
Autotransplantation
Ureteral Trauma
Bladder Trauma
Etiology
Iatrogenic Gynecology operation, endoscopy
Trauma Pelvic fracture extraperitoneal
rupture
Full bladder intraperitoneal rupture
Clinical Symptoms
History of Trauma
Sign, suprapubic hematom / pubic
Haematuria
Peritonitis.
Laboratory
Urinalysis : haematuria
Radiology
Pelvic Photo Fracture
Cystography
Therapy
Repair
Bladder Trauma
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

Anterior Urethral Trauma
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.

Posterior Urethral Trauma