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
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