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
Traffic Accident
Falling from Height
Sport injuries, Fight
2. 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 and contained vascular injury Grade V, renal artery
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 (+)
Shock(-)

Resuscitation

KUB - IVU

Shok (+) Shock (-)

Not Informative N Extravasations

N
Operatio CT-scan Observation
n 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 :
- Uretero-ureterostomy
- Implantation to the bladder
Middle ureter :
- 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
- Urinalysis : haematuria
Radiology
- Pelvic Photo Fracture
- Cystography
Therapy
- Repair
 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