UGTrauma龚宇.ppt

* Urogenital Injuries 龚 宇 2nd Affiliated Hospital,Zhejiang University Urogenital injuries in trauma patients ? Renal injury ? Ureteral injury (infrequent/iatrogenic) ? Bladder injury ? Urethral injury ? Scrotal and penile injuries (infrequent) Renal Injury Renal Protection Well protected but fragile Psoas major muscle Vertebra Ribs Capsule Perirenal fat Fascia Kidneys with existing pathologic conditions such as hydronephrosis or malignant tumors are more readily ruptured from mild trauma. Etiology 1. Blunt trauma (90-95%) Motor vehicle accidents Falls from heights Assaults 2. Penetrating trauma ( 10%) Gunshot Stab wounds Grade I Contusion or contained subcapsular hematoma without parenchymal laceration Grade II Confined perirenal hematoma or cortical laceration 1 cm deep without urinary extravasation Grade III Laceration extending 1 cm into the cortex without urinary extravasation Grade IV Laceration extending through corticomedullary junction and into the collecting system Early pathology Grade V Multiple major lacerations, “shattered” kidney Grade V Avulsion of main renal artery or vein or both Late pathology Urinoma Hydronephrosis Arteriovenous fistula Renal vascular hypertension Haematuria No correlation to extent of injury May not be present (30%) Clinical Presentation Shock Pain Mass Large retroperitoneal hematoma or urinary extravasation Large loss of blood from heavy retroperitoneal bleeding or associated injuries Flank or upper quadrants of the abdomen Diagnosis 1. History and physical examination 2. Chemical examination 3. Imaging investigation (1) Ultrasonography (Non-invasive) (2) CT (Most valuable, even plain scan) (3) IVU (4) Arteriography (DSA) Laceration Contrast-enhanced CT of the mid-abdomen reveals a linear zone of low attenuation through the left kidney with a deep renal laceration Hematoma urinary extravasation Shattered kidney Management 1. Emergency treatment 2. Conservative treatment