Gross Hematuria Following

Abdominal Wall Trauma

URINARY TRACT INJURY:
HISTORY:
1)Type of injury
Time of injury
2)Detailed history about pain:
Site, Character of pain, Radiation
3)Any other Symptoms
General Examination
• Degree of Shock
• Pulse
• Blood Pressure
• Respiration
• Temperature
• Exclude other injury:RTA,14Yyr Boy Bladder
Injury/pelvic fracture/Managed Emergency
laparotomy
Local Examination Of Abdomen
INSPECTION:Distension,
Loin swelling
PALPATION:Guarding,
Rigidity,
Tenderness,
Mass in the loin.
PERCUSSION: Shifting Dullness,
Obliteration of liver Dullness
AUSCULTATION:Absent Bowel Sounds
HEMOPERITONEUS
PERITONITIS
• Four quadrant aspiration
• P/R:Any Fluid Collection,
Pelvic Tenderness
Grades Of Renal Injury
GRADE 1: Subcapsular Non Expanding Hematoma
GRADE 2:Cortical Laceration <1cm of Depth,
No urinary extravasation
GRADE 3: Cortical Laceration >1cm of Depth
GRADE 4: Parenchymal Laceration Extenting Through
Cortex,Medulla and Collecting System, Extravasation of
Urine
GRADE 5:Shattered Kidney, Avulsion of Renal Pedicle
NEPHRECTOMY done in GRADE 4 & GRADE 5
CONSERVATIVE TREATMENT
• Bed rest
• Blood transfusion
• Intravenous Fluids
• Antibiotics
• Analgesics
• Monitor:Pulse rate, Blood pressure,Urine
examination
 INVESTIGATIONS
1.Urine Examination: Gross,
Microscopic
2.CT Scan Contrast: Extent Of Injury
Vascular Injury
3. Intravenous Urography
4.USG Abdomen: perinephric Hematoma
Hematuria Due To URETHRAL
RUPTURE
1.Bleeding through Meatus
2.Inability to Urinate
3.Perineal Hematoma
TYPES OF URETHRAL RUPTURE:
1.Partial
2.Complete
Hematuria Due To URETHRAL
RUPTURE…
INVESTIGATION:
Retrograde Cystourethrography
Injury due to fracture plevis, 16Fr Foley's Catheter
TREATMENT:
PARTIAL: Repair-Urologist
COMPLETE: Suprapubic Catheterization
Definitive Repair after 3months
POLYCYSTIC KIDNEY DISEASE
AUTOSOMAL DOMINANT TRAIT:
*Congenital Defect in the development of kidney
*Faulty development of Secretory and Collecting
tubules
Failure in fusion of Glomeruli with convoluted
tubules with the Collecting Tubules, leading to
formation of CYSTS
POLYCYSTIC KIDNEY DISEASE…
PATHOLOGY:
1. Bilateral more advanced, one kidney
2. 3-4 times Enlarged
3.Cyst contain thick yellow or dark hemorrhagic fluid
4.Atrophic Cortical Tissue
5.Hematuria
CLINICAL FEATURES:
*Asymptomatic/Renal lumps/Infection/Hypertension/Chronic
Renal Failure/Anuria
TREATMENT: Deroofing Operation/USG guided
Aspriation/Rovsin's Operation
 HYDRONEPHROSIS
ASEPTIC DILATATION OF PELVICALCYEAL SYSTEM: Due to
partial or intermittent obstruction of Urine
CAUSES: congenital /acquired
PRESENTATION: Renal lump/pain/bladder
obstruction/hematuria
GRADES OF HYDRONEPHROSIS:
GRADE 1:most minimal dilatation with slight bulging of
calyceal fornices
GRADE 2: Enlargement and obvious blunting of calyses
GRADE 3:Rounding of calyces with obliteration of papilla
shadow
GRADE 4:Extreme Calyceal balooning
 HYDRONEPHROSIS…
INVESTIGATION:
RADIONUCLIDE 99mTc DTPA SCANNING- Offer
better functional information.
HEATURIA IN GENITOURINARY
TUBERCULOSIS (GUTB)
PATHOGENESIS: 1) Endogenous
2) Exogenous
* In the form of Granuloma and Caeation
* Mycobacterium enter blood via thoracic duct, then to
various organs mainly to Kidneys(GUT)
*Communication of Caseating Granuloma with
Collecting system spread to various parts of Urinary
Tract:Calyx,Pelvis,Ureter,Bladder, Accessory Genital
Organs
HEATURIA IN GENITOURINARY
TUBERCULOSIS (GUTB)…
CHEMOTHERAPY: Healing by fibrosis, formation of
Contractures And Strictures
SYOMTOMS: Dysuria,
Back or Flank pain
Hematuria
Nocturia
Fever/weight loss/night sweats/anorexia
ANTITUBERCULOSIS
CHEMOTHERAPY
STANDARD PROGRAMMES:UTTB
INH,PAS,EMB- 2-3Months , for 18-24 months
Supplemened with STREPTOMYCIN for 2-3months 18 -
24months

GUTB SHORT COURSE CHEMOTHERAPY:

1) INH, RIFAMPICIN , PYRAZINAMIDE : Daily for
2months
 ANTI TB CHEMOTHERAPY…
FOLLOWED BY
INH , RIFAMPICIN - Double dose 3times a week for
next 2months
ALTERNATIVLY
INH/RIFAMPICIN/PYRAZINAMIDE AND STREPTOMYCIN
Daily for 2 months
Follwed by:
INH/RIFAMPICIN on DOUBLE DOSE 3 timess a week for
next 2 months
WITH THORACIC MEDICINE / ICMR COUNCIL
 Surgery in GUTB
1)Excisional
2)Ablative
3)Reconstructive
-Partial NEPHRECTOMY/EPIDIDYMECTOMY
-Non Functional Kidney
-Grossly Destroyed Kidney amd Coexistence Malignancy
-Endoscopic Dilatation In Stricture
THANK YOU