1. Urogenital Trauma Liping Xie
Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University

2. Urogenital Trauma Renal & Ureteral Injury Bladder Injury
Three to 10% of trauma patients have GU involvement; 10-15% of trauma patients with abdominal injuries have GU involvement.
Renal & Ureteral Injury
Bladder Injury
Urethral Injury
Injuries of the external genitalia

3. Renal Injury

4. Renal Injury Renal injuries constitute 45% of all GU injuries;
Most renal injuries (80%) are minor and do not require surgical intervention;
Renal trauma can happen in both blunt or penetrating trauma;
Renal injuries are most commonly from motor vehicle accidents (MVAs);

5. Renal Injury Scale

6. Renal Injury Physical examination:
Flank ecchymosis or mass indicates a retroperitoneal process but is not specific to renal injuries and rarely occurs acutely.
The most important indicator of renal trauma is gross or microscopic hematuria.
The absence of hematuria, although rare, does not exclude renal injury because it is absent in 5% of patients.

7. Renal Injury Radiographic Staging IVP - double dose
CT Scan - best method of staging - radiographic study of choice
Ultrasound
Angiography - used for suspected renovascular injury

8. CT Staging for Renal Injury
Right renal stab wound (Grade IV)
Left renal laceration

9. Management of Renal Injury

10. Surgical Management for Renal Injury

11. Ureteral Injury

12. Ureteral Injury
Ureteral injuries after external violence are rare, occurring in less than 4% of cases of penetrating trauma and less than 1% cases of blunt trauma.
Ureteral injuries after external violence, unlike renal injuries, are difficult to detect with the usual array of diagnostic tools.

13. Ureteral Injury
Excretory urography demonstrating extravasation in the upper right ureter consequent to stab wound (Arrow)

14. Surgical Management for Ureteral Injury

15. A full bladder is more likely to become injured than an empty one.
Bladder Injury
Bladder injuries classified into contusions, extraperitoneal and intraperitoneal ruptures ;
Intraperitoneal (20%)
Extraperitoneal (80%)
Rupture
A full bladder is more likely to become injured than an empty one.

16. Bladder Injury
mostly occur in blunt trauma. Eighty-five percent of these injuries occur with pelvic fractures;
15% occur with penetrating trauma and blunt mechanism without a pelvic fracture (ie, full bladder blowout).
gross hematuria in the trauma setting requires imaging of both upper and lower urinary tract

17. Bladder Injury

18. Diagnosis
Cystogram and CT are helpful diagnostic tools. Cystogram (left) shows extraperitoneal bladder rupture with extravasation into scrotum. CT(right) reveals intraperitoneal bladder rupture with contrast material surrounding bowel loops

19. Surgical Mangement of Bladder Rupture

20. Urethra Injury

21. Urethra Injury Almost exclusively in male
Most common in straddle injure
Significant morbidity
Stricture
Incontinence
Impotence
Foley catheter implication

22. Urethra Injury Posterior Urethra- Anterior Urethra-
Gross hematuria in 98%
Inability to void
Blood at urethral meatus
Pelvic / suprapubic tenderness
Penile / scrotal / perineal hematoma
Boggy / high-riding prostate/ ill-defined mass on rectal examination.
More common than posterior
Direct trauma
Usually NO pelvic injury
Blood at meatus
Unable to micturate
Penile/Scrotal/Perineal
Contusion
Hematoma
Fluid collection

23. Urethra Injury
High Riding Prostate on DRE
EXTRAVASATION OF URINE

24. Urethrogram is the best diagnostic tool-
Diagnosis
Urethrogram is the best diagnostic tool-

25. Urethrogram

26. Urethrogram Contrast extravasation + Contrast in bladder
Contrast extravasation only
PARTIAL Tear
COMPLETE Tear

27. retrograde urethrography via meatus
Urethrogram
retrograde urethrography via meatus
Extravasation of contrast medium with the “missing” bladder indicates a complete tear of the urethra

28. Management of Urethral Injury
Partial tear
careful passage of Fr. Foley.
If any resistance: Urology
Complete tear:
Urology + suprapubic cath.
If Foley already there and suspect tear:
LEAVE FOLEY IN PLACE
Initial urethral repair is not recommended because of risk of hemorrhage, impotence, and infection of pelvic hematoma.

29. Management of Urethral Injury
Surgical Repair
Bank’s Method

30. Injuries of the external genitalia
Penis
Penetrating, skin avulsion and amputation repaired surgically
“fracture” repaired and drained surgically
Scrotum/testes
Hematocele and contusion (mild) or rupture (severe, needs exploration)
Penetrating injuries need exploration

31. Injuries of the external genitalia
scrotal hematoma after straddle injure
Penile fracture

32. Thanks
This is our hospital building and you are welcome.