Genitourinary Tract Injuries: First Affiliated Hospital Of Zhengzhou University Zhang Xue-pei Md
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Genitourinary Tract Injuries First Affiliated Hospital of Zhengzhou University Zhang Xue-pei MD
Male urethra is most often seen The kidney injury is more common in developed country or during the war Occupied 10% of all injuries
Kidney injuries
Well protected by lumbar muscle . Vetebral bodies. Ribs and the anterior visera. Fracture ribs, automobile accident or sport mishaps. Blunt trauma to the kidney : 80% Associated abdominal visceral injuries are present in 80% renal penetrating wound
Early pathologic findings
1 Minor trauma : 85% . Contusion or bruising of parenchyma. Conservative treatment is enough
2 major trauma : 15%. Deep corticomedullary laceration may extend into the collected systems, result in urine extraversation. Large retroperitoneal hematomas. Multiple laceration destruct kidney
Vascular injury 1% : partial avulsion or total avulsion. Stretch on the main renal artery result in renal artery thrombosis. Difficult to find and lost the function.
Late pathological findings
Urinoma Hydronephrosis Arteryvenous fistula Renal vascular hypertension
Clinical findings
Microscopic or gross hematuria No hematuria: stab. gunshot , renal vascular injury The degree of the injury are not related to the degree of the hematuria
Need imaging exploration: hematuria with shock
Patient with microscopic hematuria need not except rapid deceleration trauma
Symptoms
Pain : flank or over the abdomen Associated injury: Hematuria Retroperitoneal bleeding: abdominal distention, ileus, nausea and vomiting
Signs
Shock : large loss of blood Ecchymosis in the flank Lower rib fracture Mass : large retroperitoneal hematoma Acute abdomen : blood in the peritoneal cavity
Laboratory Findings
Hematuria Hematocrit droping when serial studies are done indicate persistent bleeding : operation is necessary
Differential Diagnosis
IVP CT Arteriogram
Treatment
Emergency measures Shock Hemorrhage Complete resuscitation Evaluation of associated injuries
Surgical measures 1 blunt injury : Conservative treatment: absolute bed rest 2~4w Operation: persistent bleeding, urinary extraversation, nonviable renal Parenchyma or renal pedical Injuries
Penetrating injuries : Explored
Treatment of complications: urinoma and abcess demands promt Surgical drainage Hypertension: repair or nephrectomy hydronephrosis: repair or nephrectomy
Ureter Injury
Iatrogenic : the most common :endoscopic surgery Inadvertently ligated or cut during the pelvic surgery Urine leakage: urinoma, abcess, fistula, ureter stenosis, hydronephrosis
Treatment
Lower segment: reimplant to the bladder Midureteral injury: reanastomasis Upper ureteral injuries:autotransplantation, bowl replacement of ureter, ureteroureterostomy Stent : for drainage, healing, prevent urine extraversation
Bladder Injuries
Most often seen in external force :
Hematuria, unable to urinate, pain , acute abdomen, Cystography is the most useful method for diagnosis
Treatment
Repair : peritoneal, bladder wall, Drainage : peritoneal, extravasation urine, Bladder tube removed in 10days
Injuries to the Urethra
Posterior urethra (prostatic and membranous urethra) pelvic fracture
Anterior urethra (bulbous and pendulous)
Straddle injury cause laceration or contusion of the urethra
Symptoms
Posterior urethra injuries: abdominal pain, inability to urinate Anterior urethra injuries: urethral bleeding, local pain, swelling of this area, abscess
Signs
Posterior : blood at the urethra meatus, pelvis hematoma Anterior : massive urinary extravasation, in the perineum, scrotum, lower abdominal wall, the skin is also swollen and discolored
Treatment
Posterior : Shock and hemorrage should be treated first Superpubic cystostomy is enough for unstable patients Realignment of the urethra and delayed repair of the stricture is popular Immediate repair is not good for high complications
Anterior Catheterization for contusion Immediate repair Cystostomy and late repair Drainage of the leakage
Male urethra is most often seen The kidney injury is more common in developed country or during the war Occupied 10% of all injuries
Kidney injuries
Well protected by lumbar muscle . Vetebral bodies. Ribs and the anterior visera. Fracture ribs, automobile accident or sport mishaps. Blunt trauma to the kidney : 80% Associated abdominal visceral injuries are present in 80% renal penetrating wound
Early pathologic findings
1 Minor trauma : 85% . Contusion or bruising of parenchyma. Conservative treatment is enough
2 major trauma : 15%. Deep corticomedullary laceration may extend into the collected systems, result in urine extraversation. Large retroperitoneal hematomas. Multiple laceration destruct kidney
Vascular injury 1% : partial avulsion or total avulsion. Stretch on the main renal artery result in renal artery thrombosis. Difficult to find and lost the function.
Late pathological findings
Urinoma Hydronephrosis Arteryvenous fistula Renal vascular hypertension
Clinical findings
Microscopic or gross hematuria No hematuria: stab. gunshot , renal vascular injury The degree of the injury are not related to the degree of the hematuria
Need imaging exploration: hematuria with shock
Patient with microscopic hematuria need not except rapid deceleration trauma
Symptoms
Pain : flank or over the abdomen Associated injury: Hematuria Retroperitoneal bleeding: abdominal distention, ileus, nausea and vomiting
Signs
Shock : large loss of blood Ecchymosis in the flank Lower rib fracture Mass : large retroperitoneal hematoma Acute abdomen : blood in the peritoneal cavity
Laboratory Findings
Hematuria Hematocrit droping when serial studies are done indicate persistent bleeding : operation is necessary
Differential Diagnosis
IVP CT Arteriogram
Treatment
Emergency measures Shock Hemorrhage Complete resuscitation Evaluation of associated injuries
Surgical measures 1 blunt injury : Conservative treatment: absolute bed rest 2~4w Operation: persistent bleeding, urinary extraversation, nonviable renal Parenchyma or renal pedical Injuries
Penetrating injuries : Explored
Treatment of complications: urinoma and abcess demands promt Surgical drainage Hypertension: repair or nephrectomy hydronephrosis: repair or nephrectomy
Ureter Injury
Iatrogenic : the most common :endoscopic surgery Inadvertently ligated or cut during the pelvic surgery Urine leakage: urinoma, abcess, fistula, ureter stenosis, hydronephrosis
Treatment
Lower segment: reimplant to the bladder Midureteral injury: reanastomasis Upper ureteral injuries:autotransplantation, bowl replacement of ureter, ureteroureterostomy Stent : for drainage, healing, prevent urine extraversation
Bladder Injuries
Most often seen in external force :
Hematuria, unable to urinate, pain , acute abdomen, Cystography is the most useful method for diagnosis
Treatment
Repair : peritoneal, bladder wall, Drainage : peritoneal, extravasation urine, Bladder tube removed in 10days
Injuries to the Urethra
Posterior urethra (prostatic and membranous urethra) pelvic fracture
Anterior urethra (bulbous and pendulous)
Straddle injury cause laceration or contusion of the urethra
Symptoms
Posterior urethra injuries: abdominal pain, inability to urinate Anterior urethra injuries: urethral bleeding, local pain, swelling of this area, abscess
Signs
Posterior : blood at the urethra meatus, pelvis hematoma Anterior : massive urinary extravasation, in the perineum, scrotum, lower abdominal wall, the skin is also swollen and discolored
Treatment
Posterior : Shock and hemorrage should be treated first Superpubic cystostomy is enough for unstable patients Realignment of the urethra and delayed repair of the stricture is popular Immediate repair is not good for high complications
Anterior Catheterization for contusion Immediate repair Cystostomy and late repair Drainage of the leakage
