Urology – Urinary Tract Injuries: By Lee Zhao M.D. & Darren Bryk M.D.
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8 سال پیش
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Urology – Urinary Tract Injuries
Whiteboard Animation Transcript
with Lee Zhao, MD & Darren Bryk, MD
https://medskl.com/Module/Index/urina...
The urinary tract consists of the kidneys, ureters, bladder and urethra. The majority of urinary tract injuries are due to blunt trauma.
The kidney is the most commonly injured urinary tract organ and is particularly vulnerable to deceleration injuries. Evaluation begins by assessing the patient’s hemodynamic status.
Immediate surgical intervention is mandatory if the patient is unstable.
If the patient is stable and either hematuria is seen or the mechanism of trauma suggests kidney injury, IV contrast-enhanced abdominal/pelvic CT with immediate and delayed images is necessary.
Most kidney injuries are managed conservatively with observation, bed rest, hydration, hematocrit monitoring and antibiotics.
Bladder injuries are often associated with pelvic trauma. A stable patient with gross hematuria, pelvic ring fracture or suspicious mechanism of trauma is evaluated via cystography.
Extraperitoneal bladder injuries require catheter drainage and observation, while intraperitoneal injuries require surgical repair to prevent peritonitis.
Posterior urethral injuries are also associated with pelvic trauma. Prompt urinary drainage should be performed via suprapubic or urinary catheter. Urethral re-alignment can be attempted endoscopically in a stable patient but should not be prolonged.
Anterior urethral injuries are often caused by perineal trauma called straddle injuries. Patients may present with blood at the meatus, perineal hematoma, inability to void, or suspicious mechanism of trauma, associated with bicycle riding or playing on monkey bars.
Males may have penile, scrotal or testicular pain, ecchymosis or swelling, un-palpable testicle on exam, and unilateral absence of the cremasteric reflex.
Females may have vaginal bleeding; if the hymen or posterior fourchette is injured, sexual abuse is suspected.
With suspicion of child abuse, it is imperative to examine the entire body to note other abuse-related injuries.
For all suspected urethral injuries, retrograde urethrogram is the standard imaging modality used. With severe scrotal pain or swelling or with an abnormal testicular examination, ultrasound with Doppler flow to evaluate the scrotum is necessary.
It is important to recognize the signs and symptoms of urinary tract injuries early. Though most injuries are not life threatening, a delay in treatment can lead to significant morbidity. With severe injury, definitive management will require consultation with a surgical specialist.
Urology – Urinary Tract Injuries
Whiteboard Animation Transcript
with Lee Zhao, MD & Darren Bryk, MD
https://medskl.com/Module/Index/urina...
The urinary tract consists of the kidneys, ureters, bladder and urethra. The majority of urinary tract injuries are due to blunt trauma.
The kidney is the most commonly injured urinary tract organ and is particularly vulnerable to deceleration injuries. Evaluation begins by assessing the patient’s hemodynamic status.
Immediate surgical intervention is mandatory if the patient is unstable.
If the patient is stable and either hematuria is seen or the mechanism of trauma suggests kidney injury, IV contrast-enhanced abdominal/pelvic CT with immediate and delayed images is necessary.
Most kidney injuries are managed conservatively with observation, bed rest, hydration, hematocrit monitoring and antibiotics.
Bladder injuries are often associated with pelvic trauma. A stable patient with gross hematuria, pelvic ring fracture or suspicious mechanism of trauma is evaluated via cystography.
Extraperitoneal bladder injuries require catheter drainage and observation, while intraperitoneal injuries require surgical repair to prevent peritonitis.
Posterior urethral injuries are also associated with pelvic trauma. Prompt urinary drainage should be performed via suprapubic or urinary catheter. Urethral re-alignment can be attempted endoscopically in a stable patient but should not be prolonged.
Anterior urethral injuries are often caused by perineal trauma called straddle injuries. Patients may present with blood at the meatus, perineal hematoma, inability to void, or suspicious mechanism of trauma, associated with bicycle riding or playing on monkey bars.
Males may have penile, scrotal or testicular pain, ecchymosis or swelling, un-palpable testicle on exam, and unilateral absence of the cremasteric reflex.
Females may have vaginal bleeding; if the hymen or posterior fourchette is injured, sexual abuse is suspected.
With suspicion of child abuse, it is imperative to examine the entire body to note other abuse-related injuries.
For all suspected urethral injuries, retrograde urethrogram is the standard imaging modality used. With severe scrotal pain or swelling or with an abnormal testicular examination, ultrasound with Doppler flow to evaluate the scrotum is necessary.
It is important to recognize the signs and symptoms of urinary tract injuries early. Though most injuries are not life threatening, a delay in treatment can lead to significant morbidity. With severe injury, definitive management will require consultation with a surgical specialist.
8 سال پیش
در تاریخ 1395/08/17 منتشر شده
است.
38,460
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