Lower genitourinary tract injury

From greek.doctor
Revision as of 15:21, 5 October 2024 by Nikolas (talk | contribs) (Created page with "<section begin="urology" /> == Bladder injury == * Etiology ** Pelvic fracture ** Iatrogenic * Diagnosis ** CT cystography * Types ** Intraperitoneal -> injury communicates with peritoneum *** Damage of bladder dome, which is intraperitoneal ** Extraperitoneal -> injury is confined to extraperitoneal space *** The rest of the bladder is extraperitoneal * Clinical features ** Gross haematuria ** Suprapubic pain ** Inability to urinate ** Intraperitoneal -> peritoneal irri...")
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

Bladder injury

  • Etiology
    • Pelvic fracture
    • Iatrogenic
  • Diagnosis
    • CT cystography
  • Types
    • Intraperitoneal -> injury communicates with peritoneum
      • Damage of bladder dome, which is intraperitoneal
    • Extraperitoneal -> injury is confined to extraperitoneal space
      • The rest of the bladder is extraperitoneal
  • Clinical features
    • Gross haematuria
    • Suprapubic pain
    • Inability to urinate
    • Intraperitoneal -> peritoneal irritation
  • Treatment
    • Foley or suprapubic catheter
    • Extraperitoneal bladder injury -> non-operative
    • Penetrating injury -> surgery
    • Intraperitoneal bladder injury -> surgery

Urethral injury

  • Types
    • Affecting the posterior urethra
      • Due to pelvic fracture
    • Affecting the anterior urethra
      • Due to straddle injury
  • Clinical features
    • Inability to void
    • Blood at urethral opening
  • Diagnosis
    • Retrograde urethrogram
  • Treatment
    • Posterior urethra injury -> suprapubic catheter
    • Anterior urethra injury -> surgery

Penile injury

  • Usually due to traumatic bending of erect penis during intercourse
    • The tunica albuginea ruptures
    • Often associated with anterior urethra injury
  • Clinical features
    • Snapping sound as the tunica albuginea ruptures
    • Immediate loss of erection
    • Pain
    • Swelling, curving, and haematoma
      • Gives it an “eggplant” appearance
  • Diagnosis: clinical
  • Treatment
    • Surgical repair of tunica albuginea
    • Surgical evacuation of haematoma

Scrotal injury

  • Laceration of skin -> surgical repair
  • Complete scrotal avulsion -> transplant the testis into subcutaneous thigh pouches -> transplant it back into the scrotum later with a skin graft

Testicular injury

  • Blunt trauma
  • Clinical features
    • Severe pain
      • Locally and abdominally
    • Swelling
    • Nausea/vomiting
    • Haematocele
  • Diagnosis
    • Ultrasound
    • Surgical exploration
  • Treatment
    • Small haematocele -> conservative treatment
    • Large haematocele -> surgical drainage
    • Testicular rupture -> immediate surgery