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Lower Urinary Tract Trauma
Dr Charles Chabert
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Bladder Trauma Epidemiology
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
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Blunt trauma to distended bladder
Bladder Trauma Contusion Intraperitoneal Rupture at dome Blunt trauma to distended bladder Extraperitoneal Pelvic fracture BJU Int 2004, Vol 94, 27-32
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Bladder Trauma Management
Cystogram / CT Cysto Intraperitoneal Extraperitoneal Surgical Closure Catheter Drainage BJU Int 2004, Vol 94, 27-32
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Extraperitoneal Rupture
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Intraperitoneal Rupture
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Bladder Trauma Management
Cystogram / CT Cysto Intraperitoneal Extraperitoneal Surgical Closure Catheter Drainage BJU Int 2004, Vol 94, 27-32
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Catheter Drainage / Surgical
Summary Extraperitoneal Cystogram Catheter Drainage / Surgical
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Posterior Urethra Injuries
3-25% pelvic # 27% other injuries Rare in female Short, mobile lacks attachments Female 0-0.6%
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Posterior Urethra Injuries
Pelvic # Gunshot wounds Stab Wounds Iatrogenic Contusion Partial Complete with disruption
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Posterior Urethra Injuries
Blood at meatus Difficulty voiding Palpable bladder High riding prostate
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Retrograde Urethrogram
Evaluation Retrograde Urethrogram Posterior urethral Injury SPC Partial Complete SPC IDC Primary realignment
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Retrograde Urethrogram
Evaluation Retrograde Urethrogram Posterior urethral Injury SPC Partial Complete SPC IDC Primary realignment
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Immediate / delayed Realignment
Summary Pelvic # Urethrogram Immediate / delayed Realignment
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Sexual intercourse related
Penile fracture Corporal # Sexual intercourse related Cracking sound Rapid detumescence BJU Int 94;
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Penile fracture Clinical diagnosis Eggplant sign Meatal blood
Surgical exploration BJU Int 94;
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Genital Skin Loss Avulsion Animal bites Self mutilation
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Associated injuries with penetrating trauma 80%
Scrotal Trauma 85% blunt trauma 15% penetrating Associated injuries with penetrating trauma 80% BJU Int 2004, 94;
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Scrotal Trauma Management
Penetrating / Blunt Scrotal Ultrasound Suspected rupture Tunica intact Supportive care Surgery BJU Int 2004, 94;
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Supportive / exploration
Summary Blunt Ultrasound Supportive / exploration
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