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GENITOURINARY TRACT TRAUMA
Héctor Eduardo Velázquez Domínguez
KIDNEY INJURY
Kidney Injury
• Usually accompanied by mulJsystem trauma
• Work, sport, car accident
• ContusionlaceraJon/renal pedicule fracture
Clinical manifestaJons
• Hematuria • Pain and hypersensiJvity • Palpable mass
Imaging study
• RxRetroperitoneal hematoma/urinary extravasaJon
• Excretory urogram • TAC with IV contrast
ComplicaJons/TX
• Hemorrhage/shockstop bleeding and volume replacement
• Progressive hydronephrosis
• Abscess
URETER INJURY
Ureter injury
Iatrogenic: • Pelvic surgery
PenetraJng trauma
Clinical manifestaJon
• Anuria and oliguria • Ileus • Pain • Drainage to adjacent structures
• ¡Hydronephrosis!
Dx
• Excretory urogram • Retrograde uretherography
• ECO • TAC
Tx Ureteral division: • Ureteroureterostomía • Neoureterocistostomía • Transureteroureterostom
ía Ureteral resecJon • Ureteral replacement • Tie bladder to psoas • Autotransplant • IntesJnal
BLADDER INJURY
Bladder injury
• Direct trauma • Pelvic fracture • Pelvic surgery • Cystoscopy
• Intraperitoneal (40%) • Extraperitoneal (54%)
Clinical manifestaJon
• Suprapubic pain • Hematuria • Inhability to urinate
• Intraperitoneal=peritoniJs
Dx/Tx
• Rx • Cystography • Excretory urogram
• Surgery
URETRA INJURY
Uretra injury
• Anterior or posterior • Hematuria, pain, inhability to urinate
• Hematoma, InfecJon, fibrosis, erecJle dysfuncJon
THANK YOU