Genitourinary Tract

Injuries

First Affiliated Hospital of

Zhengzhou University
Zhang Xue-pei MD
 Male urethra is most often seen
 The kidney injury is more common
in developed country or during the
war
 Occupied 10% of all injuries
Kidney injuries
 Well protected by lumbar muscle .
Vetebral bodies. Ribs and the anterior
visera.
 Fracture ribs, automobile accident or
sport mishaps.
 Blunt trauma to the kidney : 80%
 Associated abdominal visceral injuries
are present in 80% renal penetrating
wound
 Early pathologic findings
 1 Minor trauma : 85% . Contusion
or bruising of parenchyma.
Conservative treatment is enough
 2 major trauma : 15%. Deep
corticomedullary laceration may
extend into the collected systems,
result in urine extraversation.
Large retroperitoneal hematomas.
Multiple laceration destruct kidney
 Vascular injury 1% : partial
avulsion or total avulsion. Stretch
on the main renal artery result in
renal artery thrombosis. Difficult to
find and lost the function.
Late pathological findings
 Urinoma
 Hydronephrosis
 Arteryvenous fistula
 Renal vascular hypertension
Clinical findings
 Microscopic or gross hematuria
 No hematuria: stab. gunshot ,
renal vascular injury
 The degree of the injury are not
related to the degree of the
hematuria
 Need imaging exploration: hematuria

with shock

 Patient with microscopic hematuria

need not except rapid deceleration

trauma
Symptoms
 Pain : flank or over the abdomen
 Associated injury:
 Hematuria
 Retroperitoneal bleeding:
abdominal distention, ileus, nausea
and vomiting
Signs
 Shock : large loss of blood
 Ecchymosis in the flank
 Lower rib fracture
 Mass : large retroperitoneal hematoma
 Acute abdomen : blood in the
peritoneal cavity
Laboratory Findings
 Hematuria
 Hematocrit droping when serial
studies are done indicate
persistent bleeding : operation is
necessary
Differential Diagnosis
 IVP
 CT
 Arteriogram
Treatment
 Emergency measures
Shock
Hemorrhage
Complete resuscitation
Evaluation of associated injuries
 Surgical measures
1 blunt injury :
Conservative treatment: absolute
bed rest
2~4w
Operation: persistent bleeding,
urinary
extraversation, nonviable
renal Parenchyma or renal pedical
Injuries
 Penetrating injuries :
Explored
 Treatment of complications:
urinoma and abcess demands promt

Surgical drainage
Hypertension: repair or nephrectomy
hydronephrosis: repair or
nephrectomy
Ureter Injury

 Iatrogenic : the most common

:endoscopic surgery Inadvertently
ligated or cut during the pelvic
surgery
 Urine leakage: urinoma, abcess,
fistula, ureter stenosis,
hydronephrosis
Treatment
 Lower segment: reimplant to the bladder
 Midureteral injury: reanastomasis
 Upper ureteral
injuries:autotransplantation, bowl
replacement of ureter,
ureteroureterostomy
 Stent : for drainage, healing, prevent
urine extraversation
Bladder Injuries
 Most often seen in external force :
 Hematuria, unable to urinate,
pain , acute abdomen,
 Cystography is the most useful
method for diagnosis
Treatment
 Repair : peritoneal, bladder wall,
 Drainage : peritoneal,
extravasation urine, Bladder tube
removed in 10days
Injuries to the Urethra
 Posterior urethra (prostatic and
membranous urethra)
pelvic fracture
 Anterior urethra (bulbous and
pendulous)

 Straddle injury cause laceration or

contusion of the urethra
Symptoms
 Posterior urethra injuries:
abdominal pain, inability to urinate
 Anterior urethra injuries: urethral
bleeding, local pain, swelling of
this area, abscess
Signs
 Posterior : blood at the urethra
meatus, pelvis hematoma
 Anterior : massive urinary
extravasation, in the perineum,
scrotum, lower abdominal wall, the
skin is also swollen and discolored
 Treatment
 Posterior :
 Shock and hemorrage should be treated
first
 Superpubic cystostomy is enough for
unstable patients
 Realignment of the urethra and delayed
repair of the stricture is popular
 Immediate repair is not good for high
complications
 Anterior
 Catheterization for contusion
 Immediate repair
 Cystostomy and late repair
 Drainage of the leakage