Hao Pan
Department of Urology, the First
Affiliated Hospital, College of
Medicine, Zhejiang University
UROLOGIC TRAUMA:
Renal Injuries;
Ureteral Injuries;
Bladder Injuries;
Urethral Injuries;
Of
Chapter 1:
Renal Trauma (etiology)
Blunt
Classification:
American Association for the Surgery of Trauma Organ Injury Severity Scale for the Kidney
Diagnosis
Patient
Grade
Grade
II
Grade
III
Grade
IV
Grade IV
Management:
Nonoperative
Management,
Most renal injuries are Grade I, can be
managed nonoperatively.
1, hospital admission and bed rest for 2-4 weeks;
Management:
Operative
Management ,
1, Absolute indications:
Management:
Operative
Management ,
Renal Exploration:
Transabdominal approach is recommended for
early exploration of the renal hilum and vasculature
to stop the bleeding.
reconstructive surgery or nephrectomy.
Complications
1.Urinoma, perinephric infection, sometimes
perinephric abscess and renal loss, which usually
followed persistent urinary extravasation.
2. Delayed renal bleeding.
3. Hypertension, (1) renal vascular injury, leading to
stenosis or occlusion of the main renal artery or one of
its branches; (2) compression of the renal parenchyma
with extravasated blood or urine; (3) post-trauma
arteriovenous fistula. In these instances, the reninangiotensin axis is stimulated by partial renal ischemia,
resulting in hypertension.
Chapter 2:
Ureteral Injuries
Ureteral
Chapter 2:
Iatrogenic Ureteral Injuries
Surgical
Classification:
American Association for the Surgery of Trauma Organ Injury
Severity Scale for the Ureter
Diagnosis
Patient history and physical examination;
Excretory urography, However, IVP findings are
often subtle and nonspecific.
Computed tomography (CT): extravasation of
contrast material.
Retrograde Ureterography (recommended).
simultaneous placement of a ureteral stent.
Excretory urography
demonstrating extravasation in
the upper right ureter consequent
to stab wound. Note lack of
contrast (arrow) in the ureter
below the site of injury, indicating
complete ureteral transection.
Management:
1. Placement of a ureteral stent;
2. Ureteroureterostomy, or so-called end-toend repair, is used in injuries to the upper
two thirds of the ureter;
3. Transureteroureterostomy;
4. Ureteroneocystostomy.
5. Autotransplantation of the kidney;
6. Transposition of bowel to replace the ureter;
7. Nephrectomy.
Chapter 3:
Bladder Injuries
Bladder injury after blunt trauma is relatively
rare owing to the protected intrapelvic position of
the bladder. Sometime bladder rupture associated
with pelvic fracture.
1 extraperitoneal
2 intraperitoneal
Diagnosis
Retrograde
Management:
1
Chapter 4:
Urethral Injuries
Classification:
1. anterior urethra (below the urogenital
diaphragm);
2. posterior urethra (above the urogenital
diaphragm).
Clinical signs:
3 X-Ray: urethrography.
2. Anastomotic urethroplasty;
Clinical signs:
1 presence of blood at the urethral
meatus;
2 inability to urinate,
4 pain
5 shock
Urethral disruption is often first detected when
a urethral catheter cannot be placed or
misplaced into pelvic hematoma.
2 X-Ray: urethrography.
Complication:
1 Urethral stenosis;
2 Impotence;
3 Incontinence .
Chapter 5:
External Genitalia Injuries.
Penile