Guidelines management

1. Anne Saputra
by. Guidelines Urological Trauma EAU 2015
UROGENITAL TRAUMA

2. ⦿ KIDNEY -> regulate blood volume and
composition, regulate pH, hormones and
excrete waste
⦿ URETERS -> Transport urine from kidney
to bladder
⦿ BLADDER -> store urine and expels
through urethra
⦿ URETHRA (Genitalia) -> discharge urine
from the body

3. EPIDEMIOLOGY
•Male > Female
•Most common injured: KIDNEY (seatbelt or steering wheel side impact
crashes)
•Rare : URETERAL (due to iatrogenic / penetrating gunshot)
•CLASSIFICATION: Blunt and Penetrating
•BLUNT :
1.Mostly BLADDER and posterior urethra (associated pelvic fracture)
2.Anterior urethra (fall-astride trauma)
Summerton et al, 2015 Guidelines on Urological Trauma EAU

4. INITIAL EVALUATION
•A-B-C-D-E
•Blunt : Bruise / hematome flank-urogenital area
•Penetrating : weapon in stabbing
•HEMATURIA (minor/gross)

5. RENAL
Jacobs, L.M., Luk, S.S., 2010. Advanced Trauma Operative
Management. 2nd ed. CineMed. Canada.

6. Summerton et al, 2015 Guidelines on Urological Trauma
EAU

7. Summerton et al, 2015 Guidelines on Urological Trauma
EAU

8. DIAGNOSTIC
1. Physical examination
2. Laboratory -> CBC, UL, RFT
3. Imaging -> Ultrasound, IVP, One-shot intraoperative, CT, MRI

10. `
Mc.Aninch JW; Surgery for Renal Trauma. in Novick AC. Stewart’s Operative Urology.
Baltimore. Williams&Wilkins Urology. 1989:234-9

11. URETER
• Incidence : mostly IATROGENIC (gynaecological,
colorectal, ureteroscopy and radical prostatectomy)
Summerton et al, 2015 Guidelines on Urological Trauma EAU

14. Zaid, U.B, et al. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep 1:119-124

15. Jacobs, L.M., Luk, S.S., 2010. Advanced Trauma Operative Management. 2nd ed. CineMed. Canada.

16. BLADDER
Classified :
1. Contusion
2. Rupture : Intraperitoneal (20%) and
Extraperitoneal (80%)
Mostly -> BLUNT trauma (85% occur pelvic
fractures)

18. Sign Symptoms
Summerton et al, 2015 Guidelines on Urological Trauma EAU

19. • Zaid, U.B, et al. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep
1:119-124

20. Diagnostic : CYSTOGRAPHY

21. Surgical Management

22. URETHRAL
Summerton et al, 2015 Guidelines on Urological Trauma EAU

24. • Zaid, U.B, et al. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep
1:119-124

25. Diagnostic : URETHROGRAPHY

28. Management
1. PARTIAL TEAR -> careful passage of 12-14Fr. foley, if any
resistance : UROLOGY
2. COMPLETE TEAR : UROLOGY + Suprapubic cath
3. If Foley already there and suspect tear : LEAVE Foley in a
place
*Initial urethral repair is not recommended, because of risk hemorrhage,
impotence and risk of pelvic infection hematoma

30. REFFERENCE
• Jacobs, L.M., Luk, S.S., 2010. Advanced Trauma Operative Management. 2nd ed. CineMed. Canada.
• Mattox, et al. 2013. Trauma. 7th ed. Mc Graw Hill. New York.
• Mc.Aninch JW; Surgery for Renal Trauma. in Novick, A.C., Streem, S.B., Pontes, J.E.. Stewart’s Operative
Urology. Baltimore. Williams & Wilkins Urology. 1989:234-9
• Metro J.M., Mc Aninch, J.W., 2003. Surgical Exploration of the injured kidney: Current Indications and
Techniques. Int bras urol. vol.29 no.2 Rio de Janiero.
• Skandalakis L.J., 2014. Surgical Anatomy and Technique. 4th ed. Springer. New York
• Summerton et al, 2015 Guidelines on Urological Trauma EAU
• Williams, N.S., Bulstrode, C.J., 2008. Bailey & Love’s Short Practice of Surgery. 25th ed. Hodder Arnold.
Great Britain
• Zaid, U.B, et al. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep 1:119-124
• Zollinger, R.M., Ellison, E.C., 2011. Atlas of Surgical Operations. 9th ed. Mc Graw Hill. New York.

31. THANK YOU