GENITOURINARY TRAUMA

NUGROHO BUDI UTOMO

UROLOGY DIV RSPAD GATOT SOEBROTO

RENAL, URETER, BLADDER

OUTLINE

Anatomy
Mechanism of injury
Correlation of anatomy and MoI
Signs and symptoms
Treatment

ANATOMY
Anterior view

Smiths General Urology 17th ed

Posterior view

MECHANISM OF INJURY
Blunt injury
diffused transverse of energy

Penetrating injury
focused transverse of energy
gun shot wound

CORRELATION OF ANATOMY AND MoI

Massive energy (blunt injury)

Related organ injuries
Remarkable findings on physical examination
Mimmicking symptoms
Very rare case (ureter)
Full bladder

SIGNS AND SYMPTOMS

Hematuria (microscopic, macroscopic)
note : the degree of hematuria doesnt refflect
degree of trauma
Flank pain
Lower abdominal pain
Peritonitis
Shock
Massive blood loss
Anuria
Lost of conciousness

SIGNS AND SYMPTOMS

Physical examination
Primary survey : Airway, Breathing,
Circulation, Disability
Secondary survey :
complete history of present and previous
illness, general state, local state : excoriation,
vulnus laceratum, vulnus punctum, inlet-outlet
wound, related organ injury

SIGNS AND SYMPTOMS

Laboratory examination
Complete blood count
Hemostasis
Renal function test
Electrolyte
Urinalisis
Blood glucose, liver function test

SIGNS AND SYMPTOMS

Radiological examination
Abdominal ultrasound (FAST)
Abdominal-pelvic plain Ro
Abdominal CT scan
One shot IVP
Other radiological exam (bone, head)

TREATMENT
IV line (2 lines if necessary) hydration
status
Put on foley catheter (diagnostic, therapeutic)
urine initial, urine color, urine production
Both above should be done parallel with
primary survey
Blood transfussion (if necessary)
Antibiotic, analgetic, hemostatic drugs
Referral (call for help)

SUPPLEMENTS

Reffered pain from kidney and ureter, Smiths Gen Urolo 17th ed

SUPPLEMENTS

Method of palpation on kidney, Smiths Gen Urol 17th ed

SUPPLEMENTS

Grade of renal injury, Smiths Gen Urol 17th ed

SUPPLEMENTS

Grade of renal injury, Smiths Gen Urol 17th ed

SUPPLEMENTS

Mechanism of bladder injury, Smiths Gen Urol 17th ed

SUPPLEMENTS

Radiologic finding of renal an ureter injury, Smiths Gen Urol 17th ed

URETHRAL CATEHTERIZATION
supine position, frog-leg position (female)
should be carried out in a sterile fashion
Grasp shaft of the penis with the
nondominant hand and hold the penis at a 90degree angle or perpendicular to the patient
2% lidocaine gel, minimum of 10 minutes, 20
to 30 mL, slow instillation time (>3 to 10
seconds)
Campbell-Walsh Urology, 10th ed

URETHRAL CATEHTERIZATION
Insert the lubricated tip of the catheter into
the urethral meatus
Entire length of the catheter should be
introduced up to the juncture of the
connector or to the two-way bifurcation
Wait for spontaneous urine passage
Balloon inflation (water)
Campbell-Walsh Urology, 10th ed

URETHRAL INJURY

OUTLINE

Anatomy
Mechanism of injury
Signs and symptoms
Treatment

ANATOMY

Anatomy of urethra, Smiths Gen Urol 17th ed

ANATOMY

Urethra
Anterior
Posterior

ANATOMY

Anatomy of penis, Smiths Gen Urol 17th ed

MECHANISM OF INJURY

Injury to the
posterior
urethra
(Straddle injury)

MECHANISM OF INJURY
Injury to the anterior urethra

SIGNS AND SYMPTOMS

Disuria
Perineal pain
Gross hematuria
Meatal bleeding
Urinary retention

SIGNS AND SYMPTOMS

Meatal bleeding
Inability to insert catheter
Perineal and scrotal bruising
High riding prostate/non palpable prostate
Pelvic fracture

TREATMENT
Immediate management
Primary survey
Secondary survey
Release urinary obstruction
single attempt catheter insertion
percutaneous cystostomy
Imaging (bipolar urethrocystogram)
Referral

SUPPLEMENTS

SUPPLEMENTS