Injuries of the genitourinary system

Injuries of the genitourinary system

Injuries to the organs of the genitourinary system are not often isolated. In case of extensive or combined trauma, it will be necessary to exclude urological pathology. The most common cause is a closed abdominal injury. Types of kidney injuries: contusions, ruptures of the medulla, pelvis, complete detachment of the kidney, or damage to the vascular bundle. The most common underlying cause of severe isolated, combined or combined kidney damage is a street or transport injury, a fall from a height, less often gunshot and stab wounds.

Kidney damage

• • Classification depending on the amount of damage and the severity of the injury
  • Small damage. No need for surgical debridement
  • Kidney bruises (80% of kidney injuries)
  • Subcapsular hematomas and superficial wounds of the cortical layer.
  • Severe injuries require early surgical intervention
  • Deep wounds reaching the pelvis
  • Multiple wounds and tears.
  • Vascular damage (with closed kidney injury in 1% of cases)
  • If the condition of the diseased is stable, then the localization of the damage can be determined using excretory urography. On urograms, the absence of signs of blood flow in the injured kidney (silent kidney) and / or leakage of the contrast agent outside the organ are noted
  • Timely diagnosis and treatment are necessary to preserve the kidney.
  • clinical picture. Regardless of the severity of the injury and its consequences, the most common manifestation is hematuria. Abdominal pain, weakness, shock are other characteristic symptoms that can mimic an acute abdomen or renal colic. Perhaps the development of local edema of the lower back. False acute abdomen, gross hematuria and palpable or ultrasound-detected urohematoma are the most striking signs of severe kidney injury. With detachment of the kidney, these symptoms are observed, but without hematuria.
  • Diagnostics
  • Approximate signs of traumatic kidney injury (subcapsular hematoma, intrarenal urohematoma, or fragmentation of the organ) can be detected by ultrasound
  • Excretory urography is the most informative
  • Angiography of the vessels of the kidney is indispensable in identifying their damage.
  • CT reliably detects parenchymal damage.
  • Complications. Late bleeding, urinoma (a cyst containing urine), perinephric abscess, ureteral obstruction associated with clot or scar formation, and hypertension.
  • Treatment and prognosis. Conservative, excluding vascular ruptures with the development of massive bleeding. In severe cases, surgery is required. The latter is indicated in all cases when a silent kidney, leakage of a contrast agent outside the urinary tract, and a growing urohematoma are determined on excretory urograms.

Bladder injury

• • Clinical picture
  • Injury to the bladder is often associated with fractures of the pelvic bones
  • An objective examination determines pain on palpation of the abdomen, tension of the abdominal muscles.
  • Diagnostics. Plain radiography reveals a concomitant fracture of the pelvic bones. The most distinct signs of bladder rupture are determined by retrograde cystography.
  • The bladder is filled with a contrast agent (within 300 ml)
  • Radiography is performed with a full bladder and after emptying it. Traces of contrast are determined outside the organ (in the abdominal cavity, pelvic cavity).
  • Treatment. A catheter is inserted through the urethra into the damaged bladder. In the case of an intraperitoneal rupture of the organ, the bladder wall is sutured and an epicystostomy is performed.

Injuries to the urethra (trauma riders)

• • clinical picture. Classic signs:
  • discharge of blood from the urethra
  • edema, bruising of the soft tissues of the perineum
  • difficulty urinating
  • palpable infiltrate, hematoma in the lower abdomen
  • associated pelvic fracture.
  • Diagnostics. Retrograde urethrography is preferred. Catheterization of the urethra threatens its complete rupture.
  • Treatment. If an injury to the urethra is diagnosed, an epicystostomy should be performed as the first and immediate stage of treatment, followed by restoration of urethral patency. A more beneficial method of treating traumatic rupture is the primary urethral suture.

Damage to the scrotum and testicles. The injury is traditionally penetrating or blunt.

• • clinical picture. Pain in the area of ​​injury. On examination, edema, skin hyperemia, hematoma are determined.
  • Diagnosis – ultrasound.
  • Treatment
  • Conservative treatment is carried out in case of preservation of the testicles, the absence of negative dynamics in the clinic
  • Surgical treatment: the scrotum tissues are restored, the wound is sutured, leaving drainage. Indications:
  • progressive hematoma
  • testicular crush
  • the wound of the scrotum penetrates deeper than the fleshy membrane (tunica dartos).

See also Abdominal injury, ICD shock. S37 Injury of pelvic organs