UROGENITAL TRAUMA

KIDNEY TRAUMA

• Often
• 8-10% blunt trauma/sharp abdomen
• Half of the incidence of urogenital trauma
• In the protection:
* Muscles of lumbar
* Ribs
* Vertebrae
Pain Rate/death OK kidney Trauma dependent:

• Degree of trauma
• Involvement of other organ trauma
• Trauma management Facilities
Trauma mechanisms

• Blunt trauma-> cause trauma

Indirect, indirect

• Direct Blunt Trauma

• KLL
• Sports
• Accident work
• Fights
• Indirect blunt Trauma
* Falling from altitude
* KLL -> causes kidney Movement Abruptly in the retro
peritonium ->avulsi renal pedicle cavity -> t.intima damage
• Can also be by iatrogenic trauma
Installation of a catheter on top of the ureters
Kidney biopsy taking
Indirect infections
Based on AAST (American for The Surgery of Trauma)
• 1st degree
Kidney Contusio/subcapsularhematom
Not expanding
Hematuria with normal imaging
2nd degree
• Perineal hematom
• Unexpanding into Retroperitonium
• Laseration superficial (< 1cm) inimplicated systim
collecting

degree 3 Renal laseration (> 2cm)

• Sub capsular Hematom
• Perinephric Hematom
• Uninvolved collecting Systim
Degree 4
• Laseration extends to collecting Systim
• Extravasated
• Trauma Vasculer -> segmental infarction
Derajat 5
• Shattered kidney
• Devaskularisasi / oklusi / trombosis
arteri / vena utama
• Laserasi komplit
• Extravasasi
• UPJ avulsi
Radiological examination

IVP
* See URINE/contrast extravasation
* Can not detect kidney trauma
Degree I, II
* Lateral counter renal function

Ultrasound
* See Hemoperitoneum
* Not recommended for renal trauma evaluation
* With color Doppler -> See vascular
CT Scan
• Sensitive and specific checks
• Determining degree of trauma
• Not invasive
• Dpt Evaluate other organs
• (Hepar, Lien, aortic)
• Contrast non contrast

Angiography
• Invasive
• Delayed renal bleeding-pseudo-aneurysm
Ureteric Trauma

Trauma to the waist, back

Risk of Ureters
OK * Protected location
* Small Size
* Mobility/Flexible
ureters trauma -> infrequently
Etiology
Outer Trauma
A. Sharp
B. Blunt

Iatrogenic ->
A. Gynecologist
B. Rectum Surgery
C. Endoscopy
Radiological examination

• IVP ( Intra Vena Pyelografi )

• RPG ( Retro Grade Pyelografi )
• USG ( Ultra Sono Grafi )
• CT Scan Abdomen
Vesika Urinaria Trauma

• Caused by: Trauma

-Blunt
-Sharp
-Iatrogenic
• In the lower pelvic/abdominal area/Perineum
60-85% Blunt trauma
15-40% Sharp trauma
Ruptur Vesika Urinaria: To
Extra peritoneum
Intra peritoneum
Both

Contusio Vesika Urinaria

A piece of Mkosa Vesika Urinaria
Wall ->bruising -> hematom

Examination:
Systography
Abdominal-Pelvic CT scan
Contusio Vesika Urinaria
Normal
Tear Drop
Easy to heal

Ruptur Vesika Urinaria

Contrast extractions
-Extra Peritonial
-Intra Peritonial
With CT Scan -> also evaluate other organs
URETHRAL TRAUMA

Etiology
• Blunt Trauma
• Translucent Trauma
• Iatrogenic
Diagnosis

• Based on clinical symptoms

• Supporting Examination -> Radiology ->RUG (Retrograde
uretrography)

• Urethral trauma Classification -> RUG Results

The -> Gold Man classification is:
"Based on anatomical damage"