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 Posterior view
Smiths General Urology 17th ed
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
Anuria
Lost of conciousness
Massive blood loss
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 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