Transcript 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 crosssectional 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.
• 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%)
AAST organ injury severity scale for the
kidney
• 1 Contusion or non-expanding subcapsular haematoma. No
laceration
• 2 Non-expanding perirenal haematoma 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)
Kidney and ureter
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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
Kidney and ureter
• Absolute indications for surgery include life
threatening renal haemorrhage
haemodynamic instability
• trauma to the ureter is relatively rare and
accounts for only 1% of all GUI
• 75% are iatrogenic
Knh 2011 and 2012
2011
2012
Total injured
25
15
males
18
Females
7
Mean age
33.2 yrs
Hospital stay mean(days)
15(2-78)
29
mortality
5
2
13
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
Urethral trauma
• Anterior urethra
• Posterior urethra
Management
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Index of suspision
Imaging
Emergency surgery
Elective surgery
treatment
• Kidney Most except penetrating managed
conservatively
• Ureter
• Surgical treatment
• Urethra spc then definitive repair