Trauma to the urinary tract and other urological emergencies

Initial resuscitation of the traumatized patient 506 Renal trauma: classification, mechanism, grading 508 Renal trauma: clinical and radiological assessment 512 Renal trauma: treatment 516 Ureteric injuries: mechanisms and diagnosis 520 Ureteric injuries: management 522 Pelvic fractures: bladder and ureteric injuries 526 Bladder injuries 532 Posterior urethral injuries in males and urethral injuries in females ...

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Trauma to the urinary tract and other urological emergencies

Oxford Handbook of Urology ◽

10.1093/med/9780198783480.003.0011 ◽

2019 ◽

pp. 515-554

Author(s):

John Reynard ◽

Simon F Brewster ◽

Suzanne Biers ◽

Naomi Laura Neal

Keyword(s):

Urinary Tract ◽

Renal Artery ◽

Renal Trauma ◽

Artery Embolization ◽

Surgical Exploration ◽

The Third ◽

Renal Artery Embolization ◽

Urological Emergencies

Management of urological trauma remains much as it was at the time of the third edition of this handbook, though selective renal artery embolization is increasingly used when compared with surgical exploration for renal trauma with persistent bleeding.

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Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.679 ◽

2017 ◽

Vol 23 (3) ◽

pp. 143

Author(s):

Tayfun Toptaş ◽

Aysel Uysal ◽

Selim Karataş ◽

Işın Üreyen ◽

Onur Erol

Keyword(s):

Urinary Tract ◽

Tertiary Care ◽

High Volume ◽

Urethral Injury ◽

Annual Number ◽

Bladder Injury ◽

Ureteric Injury ◽

Urinary Tract Injury ◽

Bladder Injuries ◽

Ureteric Injuries

Objective: To identify clinical features of urinary tract injuries detected during or after gynecologic surgeries, with a specific focus on incidence and role of surgeon and surgical route on urinary injury.Study design: The institutional database from January 2009 to January 2017 was reviewed with respect to gynecologic (non-obstetric) surgeries and urinary injuries.Results: A total of 8719 gynecologic surgeries were identified. Of these, 46 (0.52%) were found to be complicated with a bladder (N=34, 0.38%), ureteral (N=11, 0.12%) and/or urethral injury (N=1, 0.01%). Bladder injuries occurred mostly at the superior part of the bladder, while ureteric injuries at the most distal part of the ureter. Ureteric injuries were mostly delayed (81.8% vs. 5.9%, P<0.001) and were more related to thermal injury than bladder injuries (45.5% vs. 8.8%, P=0.029). Among all surgical procedures, radical hysterectomy had the highest incidence for the ureteric injury (8.53%), while Burch colposuspension via minimally invasive route had the highest incidence for the bladder injury (16.6%). Cumulative incidence of urinary injury significantly differed according to the surgical route preferred (P=0.032), with the vaginal surgeries were associated with the highest incidence (0.96%). However, there was no such a difference in injury rates between the low-volume (0.55%) and high-volume (0.52%) surgeons (P=0.328)Conclusion: Overall incidence of lower urinary tract injury at gynecologic surgeries is low, does not differ according to annual number of surgeries performed, but increases with the vaginal surgeries.

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Genitourinary injuries associated with pelvic fractures

Acta chirurgica iugoslavica ◽

10.2298/aci1302117p ◽

2013 ◽

Vol 60 (2) ◽

pp. 117-120 ◽

Cited By ~ 6

Author(s):

Tomislav Pejcic ◽

Zlatibor Loncar ◽

Dragutin Rafailovic ◽

Miodrag Acimovic ◽

Zoran Dzamic ◽

...

Keyword(s):

Pelvic Fracture ◽

Motor Vehicle ◽

Pelvic Fractures ◽

Motor Vehicles ◽

Urethral Reconstruction ◽

Tertiary Institutions ◽

Vehicle Accidents ◽

Clinical Center ◽

Bladder Injuries ◽

Urethral Injuries

Introduction: Pelvic fractures represent approximately 3% of all skeletal injuries. About 15% of patients with pelvic fractures have associated bladder or urethral injuries. The most common causes of pelvic fracture are motor vehicle accidents, motorcycle crashes, motor vehicles striking pedestrians, and falls. Material and methods: Retrospective study included the patients treated in the Emergency Center, Clinical Center of Serbia, Belgrade, between 2000 and 2009. Of 7445 patients, there were 894 injuries of the urinary tract and 376 pelvic fractures; 55 patients with pelvic fractures (14.6%) had bladder or urethral injuries. There were 31 patients with bladder injuries, 22 patients with urethral injuries, and two patients with associated injuries of the posterior urethra and the bladder neck. Results: The bladder injuries were treated by surgical exploration, cystostomy, suture of the bladder lesions and urethral catheterization. Urethral injuries were treated by primary cystostomy and urethral reconstruction and catheterization in 18 patients (82%), while cystofix-cystostomy was performed in four patients (18%). Discussion: Genitourinary injuries increase overall mortality in patients with pelvic fracture, compared with traumas without associated GU injuries. These patients require multidisciplinary approach, preferably in tertiary institutions.

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Trauma to the genitourinary tract and other urological emergencies

Urological Surgery ◽

10.1093/med/9780198769880.003.0008 ◽

2020 ◽

pp. 471-570

Author(s):

Suzanne Biers ◽

Noel Armenakas ◽

Alastair Lamb ◽

Stephen Mark ◽

John Reynard ◽

...

Keyword(s):

Trauma Patient ◽

Reconstructive Surgery ◽

Testicular Torsion ◽

Pelvic Fractures ◽

Initial Evaluation ◽

Genitourinary Tract ◽

Tissue Transfer ◽

Urethral Injuries ◽

Urological Emergencies

This chapter starts by describing the essentials in the initial evaluation of the trauma patient. It then goes on to explain how to manage renal, ureteric, bladder, testicular, penile, and scrotal injuries. It covers tissue transfer techniques in genital reconstructive surgery, anterior and posterior urethral injuries, pelvic fractures, paraphimosis, priapism, and testicular torsion.

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Risk Factors for Urethral Injuries in Men with Traumatic Pelvic Fractures

The Journal of Urology ◽

10.1016/s0022-5347(17)41703-4 ◽

1988 ◽

Vol 140 (3) ◽

pp. 506-507 ◽

Cited By ~ 49

Author(s):

Marc A. Lowe ◽

J. Tate Mason ◽

Gregory K. Luna ◽

Ronald V. Maier ◽

Michael K. Copass ◽

...

Keyword(s):

Risk Factors ◽

Pelvic Fractures ◽

Urethral Injuries

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Lower Urinary Tract Injuries: A Guide for the Emergency Radiologist

Canadian Association of Radiologists Journal ◽

10.1177/0846537120913875 ◽

2020 ◽

pp. 084653712091387

Author(s):

Parmiss Mojtabaie ◽

Ciaran E. Redmond ◽

Christopher R. Lunt ◽

Brian Gibney ◽

Nicolas Murray ◽

...

Keyword(s):

Computed Tomography ◽

Urinary Tract ◽

Lower Urinary Tract ◽

Severe Trauma ◽

Imaging Findings ◽

Significant Morbidity ◽

Urethral Trauma ◽

Emergency Radiologist ◽

Urethral Injuries ◽

Lower Urinary

Traumatic lower urinary tract injuries are uncommon and mainly occur in patients with severe trauma and multiple abdominopelvic injuries. In the presence of other substantial injuries, bladder and urethral injuries may be overlooked and cause significant morbidity and mortality. Therefore, it is important that radiologists are familiar with mechanisms and injuries that are high risk for bladder and urethral trauma. We review the imaging findings associated with these injuries and the appropriate modalities and techniques to further evaluate the patient and accurately diagnose these injuries. Computed tomography cystography and conventional retrograde urethrography are effective tools in identifying injuries to the lower urinary tract and play a crucial role in patient care and prognosis.

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Multiple Injuries to the Lower Urinary Tract: Two Cases and Comparison with the EAU Guidelines

Case Reports in Urology ◽

10.1155/2018/3216527 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

N. Lumen ◽

D. Sharma ◽

Y. Abu-Ghanem ◽

N. Djakovic ◽

F. Kuehhas ◽

...

Keyword(s):

Urinary Tract ◽

Lower Urinary Tract ◽

Clinical Decision Making ◽

Case Reports ◽

Clinical Decision ◽

Pelvic Fractures ◽

Urethral Injury ◽

Concomitant Injuries ◽

Strict Adherence ◽

Lower Urinary

Blunt trauma to the lower urinary tract is usually associated with pelvic fractures. The European Association of Urology (EAU) provides guidelines to diagnose and treat these injuries. The guidelines summarise the available evidence and provide recommendations on diagnosis and treatment of these patients. Therefore, these guidelines are important adjuncts to the urologist and emergency physician in the clinical decision-making. However, strict adherence to the guidelines is not always easy or possible because of concomitant injuries obscuring the clinical picture. This is illustrated by two case reports of concomitant injuries of the lower urinary tract (bladder with urethral injury). The clinical decisions will be discussed point by point and should serve as a practical teaching moment for the reader.

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Urological Emergencies in Patients with Multiple Traumas: Our Experience

Urologia Journal ◽

10.1177/039156039606300218 ◽

1996 ◽

Vol 63 (2) ◽

pp. 246-250

Author(s):

M. Meneguolo ◽

F. Faccioli ◽

R. Bertoldin ◽

G. D'incà ◽

S. Guazzieri

Keyword(s):

Conservative Treatment ◽

Therapeutic Approach ◽

Diagnostic Procedure ◽

Urogenital Tract ◽

Renal Trauma ◽

Urological Emergencies ◽

Multiple Traumas

The Authors describe their limited but significant experience (101 cases) regarding the diagnostic and therapeutic approach to patients with multiple traumas with involvement of the urogenital tract. Approach to the renal trauma in these patients appears to be highly controversial. Experience has shown that in cases of severe renal trauma, when the urologist is called immediately to visit the patient so that a complete and correct urological diagnostic procedure can be planned, the possibilities of conservative treatment to save the kidney are greater.

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