Презентация на тему Injury of genitourinary organs

seen in the emergency room involve the genitourinary system

define and require great diagnostic expertise.
Early diagnosis is

Emergency Diagnosis & Management

of hemorrhage and shock along with resuscitation as required.

detailed description of the accident. In cases involving gunshot

be examined for evidence of contusions or subcutaneous hematomas,

with renal injuries, and pelvic fractures often accompany bladder

Emergency Diagnosis & Management

whose blood pressure is stable can undergo more deliberate

Emergency Diagnosis & Management

suspected on the basis of the history and physical

be done in an orderly fashion so that accurate

indicates urethral injury; catheterization should not be attempted if

a urethral catheter can be carefully passed to the

the significance of hematuria cannot be determined, and other

the best imaging study to detect and stage renal

of the retroperitoneal hematoma

very rapid, but it may not detect renal parenchymal

is essential to establish whether bladder perforations exist.

bladder filled and a second one after the bladder

bladder injury.

the urethral meatus and 3 mL of water placed

of water-soluble contrast material, the urethra will be clearly

vascular injuries.

renal and ureteral injury.

be useful to detect ureteral injury, but are seldom

add substantial information during initial evaluation of severe abdominal

common injuries of the urinary system.

accidents or sporting mishaps, chiefly in men and boys..

abdomen, flank, or back is the most common mechanism,

may result in major renal trauma from rapid deceleration

present in 80% of renal penetrating wounds.

trauma usually occur in the transverse plane of the

rapid deceleration, the kidney moves upward or downward, causing

the renal artery may be caused by an intimal

indicated in all cases of major renal trauma.

occur after penetrating injuries but are not common

flow in tissue rendered nonviable by injury is compromised;

hematuria following trauma to the abdomen indicates injury to

renal vascular injury are not associated with hematuria.

renal injury does not correspond to the degree of

(1995) made the following recommendations based on findings in

examination or associated injuries prompt reasonable suspicion of a

visible evidence of abdominal trauma. Pain may be localized

hematuria.

or signs of a large loss of blood from

tenderness may be found on palpation; an "acute abdomen"

may be distended and bowel sounds absent.

or gross hematuria is usually present.

X-Ray Findings

Staging of renal injuries allows a systematic approach

X-Ray Findings
For example, blunt trauma to the abdomen associated

X-Ray Findings
Ultrasonography and retrograde urography are of little use

X-Ray Findings
Staging begins with an abdominal CT scan, the

X-Ray Findings
This noninvasive technique clearly
defines parenchymal lacerations and

X-Ray Findings
Arteriography defines major arterial and parenchymal injuries when

X-Ray Findings

The major causes of nonvisualization on an excretory

X-Ray Findings

Radionuclide renal scans have been used in staging

to the abdomen and flank areas is not always

is perhaps the most important immediate complication of renal

and expansion of palpable masses must be carefully monitored.

from renal fracture may show as an expanding mass

retroperitoneal hematoma may cause slight fever (38.3 °C), but

hydronephrosis, arteriovenous fistula, calculus formation, and pyelonephritis are important

bleeding may occur 4 weeks after injury.

Measures

The objectives of early management are prompt treatment of

Measures
Blunt Injuries
Bleeding stops spontaneously with bed rest and hydration.

Measures
Cases in which operation is indicated include those associated

Measures
Penetrating Injuries
Penetrating injuries should be surgically explored.

Measures

In 80% of cases of penetrating injury, associated organ

Measures
Treatment of Complications
Hydronephrosis may require surgical correction or nephrectomy.

Measures
Prognosis
With careful follow-up, most renal injuries have an excellent

Measures
Injuries to the Ureter
Ureteral injury is rare but may

Measures
Etiology
Large pelvic masses (benign or malignant) may displace the

Measures
Extensive carcinoma of the colon may invade areas outside

Measures
Devascularization may occur with extensive pelvic lymph node dissections

Measures
Endoscopic manipulation of a ureteral calculus with a stone

Measures
Pathogenesis & Pathology
The ureter may be inadvertently ligated and

Measures
Intraperitoneal extravasation of urine can also occur, causing ileus

partially ligated during operation, the postoperative course is usually

suspected in patients who have sustained stab or gunshot

ureter results in severe flank pain and abdominal pain

may be identified as urine by determining the creatinine

by microscopic hematuria in 90% of cases.

more rapid excretion, but persistent hydronephrosis is usually present,

excretory urogram usually appears normal, with very mild fullness

develops into a urinoma and is perhaps the best

injured side, with evidence of increasing counts owing to

symptoms similar to those of acute ureteral obstruction from

in patients with fever, ileus, and localized tenderness.

may also result in findings similar to those of

with resulting hydronephrosis in the area of injury.

best opportunity for successful repair is in the operating

nephrostomy should be considered if the injury is recognized

complete debridement, a tension-free spatulated anastomosis, watertight closure, ureteral

the ureter allow several options in management.

when possible.

injuries if extensive urinoma and pelvic infection have developed.

and are best repaired by primary ureteroureterostomy or transureteroureterostomy.

the ureter are best managed by primary ureteroureterostomy.

be stented.

endoscopically removed from the bladder.

the diagnosis is made early and prompt corrective surgery

from external force and are often associated with pelvic

gynecologic and other extensive pelvic procedures as well as

protects the urinary bladder very well. When the pelvis

is filled to near capacity, a direct blow to

is not established immediately and if the urine is

bladder rupture in 90% of cases.

history of lower abdominal trauma.

pelvic fracture may result in hemorrhagic shock, usually from

occur with intraperitoneal bladder rupture.

required in patients with pelvic trauma but not if

done, gross or, less commonly, microscopic hematuria is usually

film generally demonstrates pelvic fractures.

shown on cystography.

is extremely important, because it demonstrates areas of extraperitoneal

an excellent method for detecting bladder rupture; however, retrograde

consequent missed diagnosis of bladder rupture often occurs when

develop from extraperitoneal bladder rupture; if the urine becomes

from bladder injury when the laceration extends into the

should be treated.

abdominal incision should be made.

opened in the midline and carefully inspected.

rupture can be successfully managed with urethral catheter drainage

opened in the midline, it should be carefully inspected

extend into the bladder neck and should be repaired

should be repaired via a transperitoneal approach after careful

closed in separate layers by absorbable suture.

the pubic rami is usually present.

heavy uncontrolled bleeding from rupture of pelvic vessels even

may be necessary to leave the tapes in place

prognosis is excellent.

into the bladder neck area may be temporarily incontinent,

occur most often in men, usually associated with pelvic

may be lacerated, transected, or contused.

through the pelvic floor and voluntary urinary sphincter and

transected by the same mechanism at the interior surface

complain of lower abdominal pain and inability to urinate.

the urethral meatus is the single most important sign

of blood at the external urethral meatus indicates that

and the presence of pelvic fracture are noted on

may reveal a large pelvic hematoma with the prostate

of the prostate does not occur if the puboprostatic

the bony pelvis are usually present. A urethrogram (using

is free extravasation of contrast material into the perivesical

instrumentation involved should be for urethrography.

may be associated with posterior urethral injuries in approximately

incontinence as complications of prostatomembranous disruption are among the

repair and anastomosis occurs in about 50% of cases.

impotence after primary repair is 30-80% (mean, about 50%).

hemorrhage should be treated.

should be avoided.

should consist of suprapubic cystostomy to provide urinary drainage.

is distended by a large volume of urine accumulated

be opened in the midline and carefully inspected for

no urethral instrumentation or manipulation.

the posterior urethra heals spontaneously, and the suprapubic cystostomy

of the urethra after prostatic disruption can be undertaken

is 1 -2 cm long and situated immediately posterior

urethral catheter should be left in place along with

surgeons prefer to realign the urethra immediately.

reconstruction by a perineal approach, patients are allowed ambulation

Approximately 1 month after the delayed reconstruction, the

shows a patent area of reconstruction free of extravasation,

(< 5%), is usually very short, and urethrotomy under

be impotent for several months after delayed repair.

urethral rupture and delayed repair is rare (< 2%)

be avoided, the prognosis is excellent.

the portion distal to the urogenital diaphragm.

Contusion of the urethra is a sign of crush

A severe straddle injury may result in laceration of

usually a history of a fall, and in some

has occurred and extravasation is noted, sudden swelling in

is very tender, and a mass may be found.

should be made to pass a urethral catheter, but

of such injuries is delayed, there is massive urinary

is not usually excessive, particularly if secondary injury has

urethra shows no evidence of extravasation.

the corpus spongiosum injury may occur in the perineum

urinary extravasation are chiefly sepsis and infection.

site of injury is a common complication, but surgical

loss usually does not occur from straddle injury.

Contusion
The patient with urethral contusion shows no evidence of

the urethra following urethrography should be avoided.

extravasation is noted on the urethrogram, a voiding study

strictures are not severe and do not require surgical

Extensive Urinary Extravasation
After major laceration, urinary extravasation may involve

of urethral lacerations can be performed, but the procedure

at the site of injury may be extensive and

a major complication but in most cases does not

of the penis (penile fracture) can occur during sexual

be caused by obstructing rings placed around the base

suggest possible urethral damage, which should be investigated by

may be debrided and closed primarily. Blunt trauma may

skin may be caused by machinery accidents or other

can be done with a skin graft or thigh