Downloaded 677 times
More Related Content
Similar to Urethral & bladder injury
![bladtr [EDocFind.com].ppt](https://cdn.slidesharecdn.com/ss_thumbnails/bladtredocfind-230919181443-2598d6af-thumbnail.jpg?width=640&height=640&fit=bounds)
Urethral & bladder injury
- 1. Management of Urethral& Bladder Injuries Dr. Amar Ul Ala Butt Consultant Urologist 06 R M 12967 MOH 88/458 BCH 7/1
- 2.
- 3. Anatomy 1. Posterior urethra. •Prostatic • Membranous 2. Anterior urethra. • Bulbous • Pendolous
- 4.
- 5. Posterior urethral injuries. •Posterior urethra injured in 1.6-9.9% of pelvic fracture. • Complete: 73% • Partial: 27%
- 6. Causes. • Shearing force. •Direct laceration by pelvic bone fragment. • Distraction,caused by pelvic fracture b/w pubic symphysis & pubic rami.
- 7. Symptoms and Signs •Blood at the urethral meatus. Do not, do not, do not try to pass the catheter if it’s present!!! • Inability to urinate • Palpapable bladder • Pelvic hematoma • Superiorly dispalced prostate
- 9.
- 10.
- 11.
- 12. Treatment • Suprapubic cystostomy(Initial treatment) • If incomplete laceration – spontaneous healing in 2-3 weeks • Complete laceration – reconstruction after 3 months • Primary repair – not recommended. Surgery is difficult because of hematomas.
- 13. Complications. 1. Stricture: • Primaryrepair →50% • Delayed repair→ 5% 2. Impotence: • Primary repair →30-80% • Delayed repair →30-35% 3. Incontinence: • <2% pts • Typically ass:with sacral fracture & S2-S4 nerve injury.
- 14. Anterior Urethral Injuries •Causes. • Stradle injuries→Laceration or Contusion • Self instrumentation or iatrogenic may cause partial disruption.
- 15. Symptoms & Signs •Histry of fall • Local pain in perineum • History of instrumentation • Massive prineal hematom • Butterfly sign(hematoma)
- 17. Treatment • Contusion:.if noextravasion urethra intact,after urethrography pt:allowed to void if ok no addional treatment. • If bleeding present urethral cathetar can be done. • Laceration:.S/P cystostomy→14-21 days • Urethral cathhetar avoided bcz it converts incomplete tear to complete one. • Pts: who develops complete oclusion of urethra should have S/P for 3-6 months before definite repairs.
- 18. Bladder Trauma • Adult:Extraperitoneal organ • Bladder dome = weakest point • Blunt: 60-85% • MVA: #1 cause • Important to recognize – Pelvic/abdominal wall abscess/necrosis – Peritonitis – Intra-abdominal abscess – Sepsis / Death
- 20. Types of rupture •Extraperitoneal – Most common – Pelvic # in 89-100% – Bladder rupture in 5-10% of all pelvic # • Intraperitoneal – Extravasation of urine in abdomen – Sudden force to full bladder – Associated injuries +++ Mortality (20%)
- 21. Clinical Presentation • 98%: Gross hematuria • 2%: Microscopic hematuria + Pelvic # • 100%: Gross hematuria • 85% Pelvic # •McConnel et al. Rupture of the bladder. Urol Clin North Am. 1982. •Carroll et al. Major bladder trauma: Mechanisms of injury and a unified method of diagnosis and repair. Journal of Urology. 1984. •Morey AF et al. Bladder rupture after blunt trauma : guidelines for diagnostic imaging. Journal of Trauma-Injury Infections & Critical Care. 51(4): 683-6, 2001 Oct.
- 22. Investigation • Cystography: Goldstandard • CT Cystography : New trend • Peng et al. AJR 1999. – Prospective study – 55 patients. 5 bladder rupture – Cystography VS. CT cystography – Ruptures confirmed by Surgery – 100% sensitive and specific Peng et al. CT cystography versus conventional cystography in evaluation of bladder injury. AJR 1999; 173:1269-1272.
- 23. Investigation… Deck et al.Journal of Urology, 2000. – Retrospective study – 316 patients with CT Cystography – Sensitivity/Specificity = 95% and 100% – But 78% and 99% for intraperitoneal rupture – Comparable to Cystography alone – Identifies other injuries Deck AJ et al. CT Cystography for the diagnosis of traumatic bladder rupture. J Urol, Jul. 2000; 164(1); 43-6.
- 24. Standard Helical CT •Pao et al. Acad Radiol 2000. – With IV contrast – Misses bladder rupture – 100% sensitive if “free fluid” criteria used. – Can R/O bladder injury if NO free fluid. – Not specific. – Not accepted as diagnostic tool. Pao et al. Utility of routine trauma CT in the detection of bladder rupture. Acad Radiol 2000; 7:317-324.
- 25. Treatment • Penetrating injuries:OR • Blunt – Intraperitoneal: Almost all OR – Extraperitoneal: Urethral cath. drainage x 7- 10 days.
- 31. Conclusion • No Foleyif you suspect urethral trauma • Pelvic # + Microhematuria GU investigation • Don’t remove Foley if you suspect a partial tear of urethra afterwards.
- 32.