Lower Urinary Tract Trauma

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Lower Urinary Tract Trauma

• Dr Charles Chabert

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Bladder TraumaEpidemiology

• 1.6 blunt abdo trauma
• 90 associated with pelvic
• 6 pelvic have bladder injury
• Combined urethra bladder 15

BJU Int 2004, Vol 94, 27-32
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Bladder Trauma

• Contusion
• Intraperitoneal
• Rupture at dome
• Blunt trauma to distended bladder
• Extraperitoneal
• Pelvic fracture

BJU Int 2004, Vol 94, 27-32
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Bladder TraumaManagement

• Cystogram / CT Cysto

Intraperitoneal
Extraperitoneal
Surgical Closure
Catheter Drainage
BJU Int 2004, Vol 94, 27-32
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Extraperitoneal Rupture
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Intraperitoneal Rupture
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Bladder TraumaManagement

• Cystogram / CT Cysto

Intraperitoneal
Extraperitoneal
Surgical Closure
Catheter Drainage
BJU Int 2004, Vol 94, 27-32
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Summary

• Extraperitoneal
• Cystogram
• Catheter Drainage / Surgical

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Posterior Urethra Injuries

• 3-25 pelvic
• 27 other injuries
• Rare in female
• Short, mobile lacks attachments
• Female 0-0.6

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Posterior Urethra Injuries

• Pelvic
• Gunshot wounds
• Stab Wounds
• Iatrogenic
• Contusion
• Partial
• Complete with disruption

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Posterior Urethra Injuries

• Blood at meatus
• Difficulty voiding
• Palpable bladder
• High riding prostate

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Evaluation

• Retrograde Urethrogram

Posterior urethral Injury
SPC
Partial
Complete
SPC
IDC
Primary realignment
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Evaluation

• Retrograde Urethrogram

Posterior urethral Injury
SPC
Partial
Complete
SPC
IDC
Primary realignment
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Summary

• Pelvic
• Urethrogram
• Immediate / delayed Realignment

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Penile fracture

• Corporal
• Sexual intercourse related
• Cracking sound
• Rapid detumescence

BJU Int 94507-515
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Penile fracture

• Clinical diagnosis
• Eggplant sign
• Meatal blood
• Surgical exploration

BJU Int 94507-515
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Genital Skin Loss

• Avulsion
• Animal bites
• Self mutilation

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Scrotal Trauma

• 85 blunt trauma
• 15 penetrating
• Associated injuries with penetrating trauma 80

BJU Int 2004, 94 507-515
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Scrotal TraumaManagement

• Penetrating / Blunt

Scrotal Ultrasound
Suspected rupture
Tunica intact
Surgery
Supportive care
BJU Int 2004, 94 507-515
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Summary

• Blunt
• Ultrasound
• Supportive / exploration