Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma...

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Lower Urinary Tract Trauma Dr Charles Chabert

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Page 1: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Lower Urinary Tract Trauma

Dr Charles Chabert

Page 2: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Bladder TraumaEpidemiology

1.6% blunt abdo trauma

90% associated with pelvic #

6% pelvic # have bladder injury

Combined urethra & bladder 15%

BJU Int 2004, Vol 94, 27-32

Page 3: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Bladder Trauma

Contusion

Intraperitoneal

Rupture at dome

Blunt trauma to distended bladder

Extraperitoneal

Pelvic fractureBJU Int 2004, Vol 94, 27-32

Page 4: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Bladder TraumaManagement

Cystogram / CT Cysto

Intraperitoneal

Surgical Closure

Extraperitoneal

Catheter Drainage

BJU Int 2004, Vol 94, 27-32

Page 5: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Extraperitoneal Rupture

Page 6: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

                              

Intraperitoneal Rupture

Page 7: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.
Page 8: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Bladder TraumaManagement

Cystogram / CT Cysto

Intraperitoneal

Surgical Closure

Extraperitoneal

Catheter Drainage

BJU Int 2004, Vol 94, 27-32

Page 9: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Summary

Extraperitoneal

Cystogram

Catheter Drainage / Surgical

Page 10: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Posterior Urethra Injuries

3-25% pelvic #

27% other injuries

Rare in female

Short, mobile lacks attachments

Female 0-0.6%

Page 11: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Posterior Urethra Injuries

Pelvic #

Gunshot wounds

Stab Wounds

Iatrogenic

Contusion

Partial

Complete with disruption

Page 12: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Posterior Urethra Injuries

Blood at meatus

Difficulty voiding

Palpable bladder

High riding prostate

Page 13: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Evaluation

Retrograde Urethrogram

Posterior urethral Injury

PartialComplete

IDCSPC

Primary realignment

SPC

Page 14: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

              

                          

Page 15: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Evaluation

Retrograde Urethrogram

Posterior urethral Injury

Partial

Complete

IDCSPC

Primary realignment

SPC

Page 16: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Summary

Pelvic #

Urethrogram

Immediate / delayed Realignment

Page 17: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Penile fracture

Corporal #

Sexual intercourse related

Cracking sound

Rapid detumescence

BJU Int 94;507-515

Page 18: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Penile fracture

Clinical diagnosis

Eggplant sign

Meatal blood

Surgical explorationBJU Int 94;507-515

Page 19: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Genital Skin Loss

Avulsion

Animal bites

Self mutilation

Page 20: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.
Page 21: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.
Page 22: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Scrotal Trauma

85% blunt trauma

15% penetrating

Associated injuries with penetrating trauma 80%

BJU Int 2004, 94; 507-515

Page 23: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Scrotal TraumaManagementPenetrating / Blunt

Scrotal Ultrasound

Tunica intact Suspected rupture

Supportive care Surgery

BJU Int 2004, 94; 507-515

Page 24: Lower Urinary Tract Trauma Dr Charles Chabert. Bladder Trauma Epidemiology 1.6% blunt abdo trauma 90% associated with pelvic # 6% pelvic # have bladder.

Summary

Blunt

Ultrasound

Supportive / exploration


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