1 / 25

Managing acute urological trauma

Managing acute urological trauma. Mungai Ngugi. Genitourinary injuries (GUI). can lead to significant morbidity and mortality, incidence , severity and optimal treatment of these injuries has not been establishedin population-based cross-sectional studies

dante-stuart
Download Presentation

Managing acute urological trauma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Managing acute urological trauma Mungai Ngugi

  2. Genitourinary injuries (GUI) • can lead to significant morbidity and mortality, • incidence, severity and • optimal treatment of these injuries has not been establishedinpopulation-based cross-sectional studies • Renal injury (RI) occurs in approximately 1–5% of all traumas Baverstock R, Simons R, McLoughlin M. Severe blunt renal trauma: a 7-year retrospective review from a provincial trauma centre. Can J Urol 2001;8:1372.

  3. kidney is the most commonly injured genitourinary and abdominal organ • Blunt trauma accounts for the largest percentage of RIs (90–95%) • Penetrating injuries -more severe, higher number of associated organ injuries, and result in a higher nephrectomy rate (25–33%)

  4. AAST organ injury severity scale for the kidney • 1 Contusion or non-expanding subcapsularhaematoma. No laceration • 2 Non-expanding perirenalhaematoma cortical laceration <1 cm deep without extravasation • 3 Cortical laceration >1 cm without urinary extravasation • 4 Laceration: through corticomedullary junction into collecting system • Or Vascular: segmental renal artery or vein injury with contained haematoma • 5 Laceration: shattered kidney • Or Vascular: renal pedicle injury or avulsion The Committee on Organ Injury Scaling of the American Association for the Surgery of Trauma (AAST)

  5. Kidney and ureter • history of falls, • high-speed motor vehicle accidents, • direct blow to the flank • Pre-existing renal abnormality makes RI more likely following trauma • Haematuria • CT is the gold standard method for the radiographic assessment of stable patients with RIs

  6. Kidney and ureter • Absolute indications for surgery include life threatening renal haemorrhagehaemodynamic instability • trauma to the ureter is relatively rare and accounts for only 1% of all GUI • 75% are iatrogenic

  7. Knh 2011 and 2012

  8. bladder • 2%abdominal injuries that require surgical • repair, involve the bladder • Blunt trauma accounts for 67–86% of bladder ruptures (BR), while • penetrating trauma for 14–33% • The most common cause (90%) of BR by blunt trauma is motor vehicle accidents

  9. Urethral trauma • Anterior urethra • Posterior urethra

  10. Management • Index of suspision • Imaging • Emergency surgery • Elective surgery

  11. treatment • Kidney Most except penetrating managed conservatively • Ureter • Surgical treatment • Urethra spc then definitive repair

More Related