1. Injuries to the Genitourinary Tract
Dr. Kaveh Mehravaran
Urologist, Fellowship of Endourology & Laparoscopy
Hasheminejad Hospital

2. About 10% of all injuries seen in the emergency room involve the genitourinary system to some extent.
The history should include a detailed description of the Accident
The abdomen and genitalia should be examined for evidence of contusions or subcutaneous hematomas, which might indicate deeper injuries to the retroperitoneum and pelvic structures.
Fractures of the lower ribs are often associated with renal injuries, and pelvic fractures often accompany bladder and urethral injuries.

3. Special Examinations Catheterization Computed tomography
Retrograde cystography
Urethrography
Arteriography
Intravenous urography
CYSTOSCOPY
ABDOMINAL SONOGRAPHY

7. INJURIES TO THE KIDNEY
Renal injuries are the most common injuries of the urinary system.
Kidneys with existing pathologic conditions such as hydronephrosis or malignant tumors are more readily ruptured from mild trauma.
Blunt trauma directly to the abdomen, flank, or back is the most common mechanism, accounting for 80–85% of all renal injuries.

10. LATE PATHOLOGIC FINDINGS
Urinoma
Hydronephrosis
Arteriovenous fistula
Renal vascular hypertension

12. Treatment EMERGENCY MEASURES
Blunt injuries:Cases in which operation is indicated include those associated with persistent retroperitoneal bleeding, urinary extravasation, evidence of nonviable renal parenchyma, and renal pedicle injuries
Penetrating injuries
TREATMENT OF COMPLICATIONS

13. INJURIES TO THE URETER Etiology SYMPTOMS SIGNS LABORATORY FINDINGS
IMAGING FINDINGS

14. Treatment
The best opportunity for successful repair is in the operating room when the injury occurs.
If the injury is not recognized until 7–10 days after the event and no infection, abscess, or other complications exist, immediate reexploration and repair are indicated.
Proximal urinary drainage by percutaneous nephrostomy or formal nephrostomy should be consideredif the injury is recognized late or if the patient has significant complications that make immediate reconstruction unsatisfactory.

15. INJURIES TO THE BLADDER
Bladder injuries occur most often from external force and are often associated with pelvic fractures. (About 15% of all pelvic fractures are associated with concomitant bladder or urethral injuries.
SYMPTOMS
SIGNS

17. Treatment
Extraperitoneal bladder rupture
Intraperitoneal rupture

18. INJURIES TO THE URETHRA INJURIES TO THE POSTERIOR URETHRA
Etiology
SYMPTOMS
SIGNS
X-RAY FINDINGS
INSTRUMENTAL EXAMINATION

19. Treatment Immediate management Delayed urethral reconstruction
Immediate urethral realignment

20. INJURIES TO THE ANTERIOR URETHRA
Etiology
SYMPTOMS
SIGNS
X-RAY FINDINGS

21. Treatment Urethral contusion Urethral lacerations
Urethral laceration with extensive urinary extravasation
Immediate repair

22. INJURIES TO THE PENIS
INJURIES TO THE SCROTUM
INJURIES TO THE TESTIS

23. TORSION
Obstructive uropathy