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Urinary Tract

Trauma

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

2.

Traffic Accident
Falling from Height
Sport injuries, Fight

Penetrating Trauma

Stab wound
Gunshot wounds

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

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

Schema of Renal
Trauma

Renal Trauma

Renal
Trauma

Shock (+)

Shock(-)

Resuscitation
KUB - IVU
Shok (+)

Shock (-)
Not Informative

Operatio
n

CT-scan

Extravasations

Observation
Operation

Operatio

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 :

Middle ureter :

Uretero-ureterostomy
Implantation to the bladder
Uretero-ureterostomy
Trans-uretero-ureterostomy

Proximal ureter :

Uretero-ureterostomy
Nephrectomy
Autotransplantation

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.

Bladder
Trauma

Laboratory

Radiology

Urinalysis : haematuria
Pelvic Photo Fracture
Cystography

Therapy

Repair

Urethral Trauma
Anterior Urethral Trauma

Position : Distal from urogenital


diagphram
Etiology :

Clinical Signs :

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

Radiology : urethrogram
Therapy : immediate repair

Anterior Urethral
Trauma

Posterior Urethral
Trauma

Etiology

Clinical Symptoms

Blood from meatus


Urinary retention
Pain, hematom on pubic region

Radiology

Pelvic bone fracture

Pelvic Photo
Urethrogram

Therapy

Sistostomy
Repair 3-4 days later.

Posterior Urethral
Trauma