Managing acute urological trauma

Mungai Ngugi

Genitourinary injuries (GUI)

• can lead to significant morbidity and mortality,• incidence, severity and• optimal treatment of these injuries has not

been establishedin population-based cross-sectional studies

• Renal injury (RI) occurs in approximately 1–5% of all traumas

Baverstock R, Simons R, McLoughlin M. Severe blunt renal trauma:a 7-year retrospective review from a provincial trauma centre. Can J

Urol 2001;8:1372.

• kidney is the most commonly injured genitourinary and abdominal organ

• Blunt trauma accounts for the largest percentage of RIs (90–95%)

• Penetrating injuries -more severe, higher number of associated organ injuries, and result in a higher nephrectomy rate (25–33%)

AAST organ injury severity scale for the kidney

• 1 Contusion or non-expanding subcapsular haematoma. No laceration

• 2 Non-expanding perirenal haematoma cortical laceration <1 cm deep without extravasation

• 3 Cortical laceration >1 cm without urinary extravasation• 4 Laceration: through corticomedullary junction into

collecting system• Or Vascular: segmental renal artery or vein injury with

contained haematoma• 5 Laceration: shattered kidney• Or Vascular: renal pedicle injury or avulsion

The Committeeon Organ Injury Scaling of the American Association

for the Surgery of Trauma (AAST)

Kidney and ureter

• history of falls,• high-speed motor vehicle accidents,• direct blow to the flank• Pre-existing renal abnormality makes RI more

likely following trauma• Haematuria• CT is the gold standard method for the

radiographic assessment of stable patients with RIs

Kidney and ureter

• Absolute indications for surgery include life threatening renal haemorrhage haemodynamic instability

• trauma to the ureter is relatively rare and accounts for only 1% of all GUI

• 75% are iatrogenic

Knh 2011 and 2012

2011 2012

Total injured 25 15

males 18

Females 7 13

Mean age 33.2 yrs

Hospital stay mean(days) 15(2-78) 29

mortality 5 2

bladder

• 2% abdominal injuries that require surgical• repair, involve the bladder • Blunt trauma accounts for 67–86% of bladder

ruptures (BR), while• penetrating trauma for 14–33% • The most common cause (90%) of BR by blunt

trauma is motor vehicle accidents

Urethral trauma

• Anterior urethra• Posterior urethra

Management

• Index of suspision• Imaging• Emergency surgery• Elective surgery

treatment

• Kidney Most except penetrating managed conservatively

• Ureter • Surgical treatment• Urethra spc then definitive repair