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Trauma of Urinary Tract

Dr.M.Galuh Richata,SpU

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Trauma of Urinary Tract

Trauma of the:

Kidney

Ureter

Bladder

Urethra

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Basic Principle

of Trauma Life Support

Primary Survey

A = Airway Control and C-Spine Control

B= Breathing Control and Adequate

Oxygenization

C= Circulation Control and Bleeding Control

D= Disability

Secondary Survey:

E= Exposure and Environment Control

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Trauma of the Kidney

Blunt Trauma (most common mechanism,80-85% of all renal injuries, cause: vehicleaccidents, falls, fights, contact sports)

Penetrating Trauma (gunshot, knife)

Rapid Deceleration Trauma (vehiclecollisions, falls)

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Kidney Trauma

Signs & Symptoms Pain (localized to flank, or over abdomen)

Hematuria

Retroperitoneal bleeding abdominal

distention, ileus, nausea & vomiting

Shock (large loss of blood)

Ecchymosis in the flank or UQ abdomen

Palpable mass Blood into the peritoneal cavity acute

abdomen diffuse abdominal tenderness,bowel sounds absent.

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Kidney Trauma

Laboratory Findings Urine : Hematuria (gross/microscopic)

Blood: serial hematocrit shows a decline

Imaging

CT Scan with IV contrast

IVU with double dose IV contrast

Arteriography Ultrasound (not sensitive)

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Kidney Trauma

Classification of Renal Injuries

Grade I:

- Contusion- Subcapsular Hematoma

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Kidney Trauma

Grade II:- Confined perirenal

hematoma

- Cortical laceration < 1 cm

- No urine extravasation

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Kidney Trauma

Grade III:- Laceration > 1 cm

(into the cortex)

- No urine extravasation

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Kidney Trauma

Grade IV:- Laceration into

corticomedullary junction

and into the collecting

system

(urine extravasation)

- Laceration to segmental

vessel may present

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Kidney Trauma

Grade V:- Multiple major lacerations

(shattered kidney)

- Avulsion of the main

renal vessel

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Kidney Trauma

ManagementMinor Renal Trauma (grade I-III)

- Mostly do not need exploration

- Bed rest, hydration, monitoring

Major Renal Trauma (grade IV-V)

- Exploration through Laparatomy

Most penetrating injuries needs exploration

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Trauma of the Ureter

Quite rare

Mostly due to:

Instrumental trauma during pelvic surgery

Penetrating injuries (knife or gunshot)

Rapid deceleration accidents.

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Trauma of the Bladder

Mostly from external force (oftenassociated with pelvic trauma/fractures)

Other cause: Instrumental trauma during

pelvic/gynaecologic surgery

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Trauma of the Bladder

Types of Bladder Ruptures Extraperitoneal Rupture

- Most common

- Associated in pelvic fractures

Intraperitoneal Rupture

- Extravasation urine in the peritoneumcavity

- Sudden force to a full bladder

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Trauma of the

Urethra

Occur most in men

Associated with:

- Pelvic fractures

Posterior Urethra

- Straddle injury

Anterior Urethra

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Trauma of the Urethra

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Trauma of Posterior Urethra

Commonly occur

from blunt trauma

and pelvic

fractures.

Urethra rupture at

the proximal of

urogenitaldiaphragm

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Trauma of Posterior Urethra

Signs & Symptoms- Inability to urinate/void (retentio urine)

- Lower abdominal pain, suprapubictenderness

- History and presence of crushing injury tothe pelvis

- Meatal bleeding (most important sign!)

- DRE: Large pelvic hematoma withprostate displaced superiorly (floating

prostate/high riding prostate)

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Trauma of Anterior Urethra

Commonly caused by Straddle In jury

Mechanism: A blow to perineal region orfall astride an object, with the perineal

region hit the object. The urethra iscrushed between the object and theinferior edge of the symphysis.

Other cause: instrumentation such ascatheterization.

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Trauma of Anterior Urethra

Signs & Symptoms- Mostly same with

Posterior Trauma

- Swelling &hematoma of the

scrotum

- Hematoma of theperineal region

(butterfly hematoma)

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Trauma of the Urethra

ImagingRetrograde Urethrography

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Retrograde Urethrography

If there is contrast extravasation

with contrast in the bladder

Part ial rup tu re

If there is only contrast extravasation

(no contrast in the bladder)Complete Rup ture

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Retrograde Urethrography

Part ial Rup ture

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Retrograde Urethrography

Complete Rup ture

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Trauma of the Urethra

Management Absolute contraindication for

catheterization

Indication for Cystostomy or BladderPuncture.