1. INJURIES TO THE GENITOURINARY TRACT
S.Vahidi

2. Special examination A.Catheterization and assessment of injury
2-CT scan
3-retrograde cystography
4-urethrography
5-arteriography
6-IVP
B.Cystoscopy and retrograde urography
C.Abdominal sonography

3. Injuries to the kidney Etiology
-most common injuries of urinary system
-kidney with existing pathologic condition are more readily ruptured
Etiology
-Blunt trauma(80-85%)
-Penetrating truma to the flank area should be regarded as a cause of renal injury until proved otherwise
-Associated abdomial visceral injuries are present in 80% of renal penetrating wounds

4. Pathology & classification
A-early pathologic finding
1)-grade I (the most common)renal contusion
microscopic hematuria
2)-grade II renal parenchymal laceration
perirenal hematoma
3)-grade III laceration extending into the renal medulla
large retroperitoneal hematoma
4)-grade IV laceration extending into the renal
collecting system-artry injuries
5)-grade V multiple gIV –renal pedicle avulsion
main renal artery or vein from penetrating
trauma

5. Pathology & classification (continue)
B-late pathologic findings
1-urinoma
2-hydronephrosis
3-arteriovenous fistula
4-ranal vascular hypertension

6. Treatment A.Emergency measures B.Surgical measures 1)Blunt inguries
85% no operation require
operation indicated in:
-persitent retroperitoneal bleeding
-Urinary extravasation
-non viable parenchyma
-renal pedicle injuries

7. Treatment(continue)
2)Penetrating injuries exploration is needed rare exception:minor parenchymal injury with no U. extravasation in 80% of cases:associated organ injury

8. Treatment(continue) C.Treatment of complications:
urinoma & abscass:drainage
malignant hypertention:vascular repair
or nephrectomy
hydronephrosis:surgical correction or
nephrectomy

9. prognosis
-excellent prognosis
-IVP & BP monitoring is needed

10. Injuries to the ureter Etiology: Clinical finding: Lab exam:hematuria.
-iatrogenic:tul-pelvic surgery
-deceleration accident:avulse the ureter
Clinical finding:
-signs & symptoms:fever- flank pain-nausea &
vomiting-urinary leakage
(within first 10 postoperative days).ileus
Lab exam:hematuria.

11. Imaging IVP-retrograde ureterography-spiral CT: extravasation
hydronephrosis
Sonography:hydronephrosis-urinoma
Radionuclide examining:delayed excretion accumulation in renal pelvis

12. Differential diagnosis
Bowel obstruction deep wound infection Peritonitis acute pyelonephritis Fever

13. Treatment The best opportunity:in the operating room- until 7-10 days
Lower ureteral injuries:reimplantation-ureteroureterostomy-bladder tube flap-trans- ureteroureterostomy
Midureteral injuries:ureteroureterostomy or trans u. ureteostomy
Upper ureteral injuries:ureteroureterostomy-auto transplantation-bowel replacement
Stenting
Prognosis:excellent

14. Injuries to the bladder
Usually due to external force
Often associated with perlvic fracture(15% of pelvic fractures)
iatrogenic injury

15. Clinical findings Pelvic fracture : crepitus-painful
Unable to urinate- Hematuria
Hemorrhagic shock
D.R.E.: distinct landmarks

16. Lab:Hematuria X-ray:pelvic fracture-extravasation Complications:pelvic abscess-peritonitis-incontinency(partial)

17. Treatment
Extraperitoneal:foley cath (bladderneck injury-large bloodclots→surgical management)
Intraperitoneal:surgical repair
Prognosis :excellent

18. Inguries to the urethra
Clinical findings:lower abdominal pain-inability to urinate-blood at the uretheral meatus-prostate displacement-perineal hematoma
X-Ray findings:pelvic fracture-extravasation
Complications:stricture-impotency-incontinency

19. Treatment Immediate management : cystostomy
Delayed urethral reconstruction urethroplasty.
Immediate urethral realignment