Start studying chapter 36 abdominal and genitourinary trauma. Discuss the evaluation and treatment of a patient1234 5 with genitourinary trauma. Similarly, trauma to the genitourinary system is often overlooked, despite 10% of all trauma patients having some form of genitourinary injury. A european registry of road traffic crash victims compiled between 1996 and 2001 recorded trauma to the genitourinary system in 0. Hollow organ injuries stomach usually injured due to blunt trauma full stomach prior to incident risk of injury spillage of contents into peritoneal cavity immediate pain, tenderness, guarding, and rigidity small and large intestines usually injured due to penetrating trauma spillage of contents into. Evaluation and management of patients who have traumatic injuries to the genitourinary tract have undergone. Penile trauma is less common than scrotaltesticular trauma, but still comprises 1016% of genitourinary injuries per several single institution series. The rise in genitourinary battlefield injuries can be largely attributed to changing mechanisms of modern combat and the proliferation of improvised explosive. Genitourinary injuries occur in 1020% of major trauma patients. Most of these injuries, with the exception of renal hilar disruption or shattered kidney, are not immediately life threatening. Genitourinary trauma in the modern era of warfare journal. To avoid the subsequent morbidity, a high index of suspicion must be maintained, and the appropriate radiographic evaluation performed. The genitourinary system may be exposed to a variety of possible injuries from the time the fetus develops.
Renal injury is common, occurring in 810% of cases of blunt and penetrating trauma. Genitourinary system an overview sciencedirect topics. Identification of these injuries is essential as they can be overlooked in the setting of multitrauma. Management depends on what part of the urethra was injured and to what extent. Typically caused by trauma from surgery or during delivery, a genitourinary fistula tract will cause urine to be directed away from its normal location in the ureters tubes that bring urine from the kidney to the bladder, bladder or urethra. Start studying chapter 35 abdominal and genitourinary trauma. Emergency management of renal and genitourinary trauma. Crack cast show notes genitourinary trauma october 2016. Injury to the genitourinary tract is a common occurrence after both blunt and penetrating trauma.
Management of genitourinary trauma smith 1968 aorn. Genitourinary trauma involves injury to the kidneys, ureters, bladder, andor urethra. Pdf on jun 1, 2012, timothy c hardcastle and others published chapter 263. See initial management of trauma in adults and initial evaluation and management of blunt abdominal trauma in adults and pelvic trauma.
In these cases, additional imaging studies to assess for genitourinary injury occur later, outside of the emergency department. Genitourinary trauma and reconstruction team penn medicine. Individuals may suffer from congenital disorders, cancer, trauma, infection, inflammation, iatrogenic injuries, or other conditions that may lead to genitourinary organ damage or loss and necessitate eventual reconstruction. Concomitant genitourinary gu injury, especially to the kidney, occurs in up to 40% of patients with abdominal trauma. During the global war on terror, rates of genitourinary injuries have increased by nearly 350%. They usually result from gunshot wounds and rarely from stab wounds. The close cooperation between radiologists and urologists is essential for the most. Delayed recognition of these injuries may have the unique complication of urinary extravasation. We provide both acute care in the trauma setting as well as a wide range of reconstructive options for patients who have suffered complex injuries to the. Emergency management of renal and genitourinary trauma eb.
Genitourinary gu organs are commonly injured in trauma patients. Genitourinary injury occurs in 25% of all trauma patients and in at least 10% of patients with abdominal trauma, emphasizing the need for a close collaboration between the. Ct with iv contrast is the gold standard in assessing renal and gu trauma more sensitive and specific than ivp, ultrasound, or angiography however, can miss significant injuries to the renal pelvis, collecting system and ureter given ct generally obtained before contrast is excreted in the urine. Because they are often accompanied by potentially lifethreatening injuries to other organ systems, it is easy for the emergency physician to overlook. Abdominal and genitourinary trauma authorstream presentation. In up to 10% of patients who experience abdominal trauma, renal and urogenital systems will be involved. Other injuries often take priority over injuries to the gu system and may initially interfere or postpone a complete urologic assessment.
Gu trauma is broadly divided into blunt and penetrative and based on the. In particular, pelvic fractures may be the source of major hemorrhage. Genitourinary trauma, diagnostic evaluation of practice. Chapter 35 abdominal and genitourinary trauma flashcards.
This article describes the care of the patient with genitourinary trauma focusing on assessments, diagnostic testing, and patient care. Fortunately, the incidence of lower urinary tract injury in children is quite low, estimated at 0. The urologist remains an important consultant to the trauma team, helping to ensure that the radiographic evaluation of urogenital structures is performed efficiently and accurately, and that the function of the genitourinary system is preserved whenever possible. In children, avulsion injuries are more common and occur at the ureteropelvic junction. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Damage to the kidney represents the most common type of urinary tract injury. In one large civilian study, penetrating penile trauma accounted for 33% of all penetrating genital trauma scrotum48%. Pdf on jan 1, 2018, liaqat ali and others published genitourinary trauma find, read and cite all the research you need on. Alright, now in this part of the article, you will be able to access the free pdf download of rosens emergency medicine 8th edition pdf using our direct links mentioned at the end of this article. Genitourinary trauma an overview sciencedirect topics. Genitourinary trauma penns level 1 trauma center provides comprehensive care for trauma injuries to any genitourinary organ, including complex injuries of the kidneys, bladder, and urethra. Management relies upon manual replacement and secondary orchidopexy. Jan 23, 2017 because trauma is a multisystem disease, multiple injuries may be present in the trauma patient. Approximately 10 percent of patients suffering injuries severe enough to require admission to a trauma service sustain injury to the genitourinary tract.
Urologic injury often occurs in the context of severe multisystem trauma that requires close cooperation with trauma surgeons. The incidence of penetrating trauma is also increasing, which is seen particularly in inner city trauma centers, and is becoming a major cause of renal injury 3, 4. It may result in high morbidity if not properly identified and managed. Cureus impact of genitourinary injuries on patients. The two broad anatomical separations are the posterior and anterior urethra. In this article, we discuss the role of imaging in the management of patients with genitourinary trauma. Genitourinary trauma has become increasingly commonplace in the modern era of warfare. Genitourinary trauma and reconstruction program penn medicine. Lower genitourinary tract trauma david bayne, uwais zaid, amjad. List the different types of genitourinary trauma 1234 5 and their possible causes. Because trauma is a multisystem disease, multiple injuries may be present in the trauma patient.
The posterior urethra includes the prostatic and membranous urethra. Timely identification and management of genitourinary injuries can minimize the associated morbidity, which may include impairment of urinary continence and sexual function. Urotrauma guideline american urological association. Genitourinary trauma knowledge for medical students and. Chapter 36 abdominal and genitourinary trauma flashcards.
Genitourinary trauma is a common finding in the patient with multitrauma, and includes injuries to the kidneys, bladder, ureters, urethra, penis, and scrotum. When compared to our abdominal trauma patients without gu injuries, those with gu trauma had a higher severity of injury iss 2111 vs 1610 and higher mortality rates 26% vs 16%, p genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid longterm urinary sequelae such as hypertension, incontinence, erectile dysfunction, chronic kidney disease, and nephrectomy. Blunt injuries to the bladder typically result from a blow to the lower abdomen when the bladder is distended or when the pelvis is fractured. The close cooperation between radiologists and urologists is essential for the most effective management of genitourinary trauma. Renal injuriesrenal injuries ureteral injuries bladder injury urethral injuries 3. Noniatrogenic ureteral injuries account for only about 1 to 3% of all genitourinary trauma.
Genitourinary injury occurs in 25% of all trauma patients and in at least 10% of patients with abdominal trauma, emphasizing the need for a close collaboration between the general and urologic trauma surgeon. Genitourinary trauma and reconstruction team this list represents the breadth of penn medicine providers who specialize in the treatment and management of genitourinary trauma, often working together as a team to provide the highest level of patient care. Genitourinary trauma, management of practice management. Injuries to the lower genitourinary gu tract alone are not life threatening, but their association with other potentially more significant injuries necessitates an organized approach to diagnosis and management. Identification of these injuries is essential as they can be overlooked in the setting of multi trauma. In polytrauma patients with other potentially lifethreatening injuries, renal and genitourinary trauma may be overlooked initially, but a delayed or missed diagnosis of these injuries may result in preventablecomplications. Abdominal and genitourinary trauma vicki bacidore abdominal injuries are a significant source of morbidity and mortality, ranking third as a cause oftraumatic death, preceded only by injuries to the head and chest. The majority of these injuries approximately 80% are the result of a blunt trauma mechanism. For trauma patients in the ed, life and limbthreatening injuries take priority, but renal and genitourinary injury can have longterm consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems. Current practices, as well as old and more recent controversies involving diagnostic and therapeutic approaches, are discussed. Approximately 10% of trauma patients sustain injury to the genitourinary system. Jan 24, 2017 because trauma is a multisystem disease, multiple injuries may be present in the trauma patient. Mohamed shafikurology department alexandria university 2.
The incidence of urological tract injury following. Small size, mobility, protected location 1% of all urinary tract trauma. Genitourinary trauma trauma, 8e accesssurgery mcgraw. Rosens emergency medicine 8th edition pdf free download. Other injuries often take priority over injuries to the genitourinary gu system and may initially interfere or postpone a complete urologic assessment. Protected because of the symphysis pubis and its shorter length retrograde urethrography is not recommended in the er. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Adrenal trauma incidence and significance trauma to the adrenal glands is unusual because of their relatively wellprotected position deep in the retroperitoneum, so injury to these organs occurs in the setting of mas. Penetrating genitourinary trauma has a more straightforward imaging approach than blunt trauma. Trauma genitourinary free download as powerpoint presentation. In many cases, laparotomy may be needed to assess for other abdominal and pelvic injuries. The diagnosis of genitourinary trauma typically relies on patient history, physical examination, urinalysis, and imaging ct, cystoscopy, retrograde urethrogram.
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