Injury of genitourinary organs

1. INJURY OF GENITOURINARY ORGANS

2. Renal Injury

can be closed and open. In case of
the former there is no damage of
dermal integuments, in the latter –
a percutaneous wound canal is
present owing to a gunshot wound
or a stab.

3. It is possible to divide injuries accompanied by lacerations of tissues of the kidney into five groups

4. Types of closed renal trauma:

1.
2.
Damage of fibrous capsule of the kidney
and paranephral fat; the latter may be
imbibed with blood.
Parenchyma of the kidney is damaged,
but the rupture does not reach the
pyelocaliceal system. The urinary
infiltration of tissues surrounding the
kidney is not present.

5. Types of closed renal trauma:

3.
4.
Ruptures of the renal parenchyma reach
the pyelocaliceal system. A profuse
hematuria and pararenal urohematoma
are observed.
Crushing of the kidney. Serious trauma is
accompanied by a considerable bleeding,
urinary infiltration of tissues.

6. Types of closed renal trauma:

5.
Abruption of the kidney from its vascular
pedicle. Thus, there is an expressed
bleeding, that can result in a fatal
outcome owing to acute blood loss and
shock.

7. Clinical presentions in renal injury consist basically of pain in the lumbar area, tumescence, hematuria, and in open renal injuries – a discharge of urine from the wound.

8. The most frequent (in 90% of cases) and relevant sign of trauma of the kidney is hematuria.

9. In open renal injury the patient’s condition in most cases is serious. The signs of renal injury in combined wounds can be not so expressed, since others dominate – peritoneal, hemothorax, etc.

10. The main method of diagnostics of renal injury is the X-ray examination.

11. The most useful investigation is a renal angiogram.

12. The ultrasonic investigation of the kidneys, permitting to define focal changes in the affected kidney, as well as the condition of the tissues, surrounding it, is very convenient.

13. Treatment

14.

15. Ureteral Injuries

16. Ureteral Injuries

Diagnostics

17. Ureteral Injuries

Open ureter injuries

18. In wounds of the ureters the following methods of operative treatment are used:

1.
2.
If there is no loss of length and the cut ends
of the ureter can be brought together without
tension, they should be joined by a spatulated
anastomosis over a double pigtail catheter.
If the transection is very low, the bladder wall
may be pulled up so that the ureter can be
reimplanted into it. An extra length may be
obtained by mobilizing the kidney.

19. In wounds of the ureters the following methods of operative treatment are used:

3. The ureter may be implanted in the end-to-side
fashion into the contralateral ureter. The
disadvantage of transureterostomy is that it risks
converting a unilateral injury into a bilateral one.
4. Occasionally, when preservation of all renal tissues
is vital, replacement of the damaged ureter by a
segment of ileum is necessary.
5. Nephrectomy may be the best way out when the
patient’s condition is poor and the other kidney is
normal.

20. Complications of ureter injuries may be:

-
their strictures
ureterohydronephrosis
chronic pyelonephritis
nephrolithiasis
a nephrogenic arterial hypertension
others

21. Bladder Injury

22. Extraperitoneal ruptures

23. Intraperitoneal ruptures

24. Sympomatology

25. Treatment

Operations in which the bladder is liable
to be injured include:
1. Inguinal of femoral herniotomy
2. Hysterectomy by either the
abdominal or vaginal route
3. Excision of the rectum

26. Urethral Injury

27. Symptomatology

28. Treatment

The main complication of urethra
injures is its gradual cicatrization,
narrowing and formation of
posttraumatic strictures.

29. Trauma of the Testicle

30. Trauma of the Penis