Injuries of urinary tract and male reproductive system

INJURIES OF THE URINARY TRACT AND MALE GENITALIA represent important urological emergencies and are often associated with trauma. These injuries may result from blunt, penetrating, or iatrogenic mechanisms. The urinary tract includes the kidneys, ureters, bladder, and urethra, all of which may be affected by trauma. Renal injuries are the most common type of urinary tract trauma. Hematuria is a key clinical sign suggesting injury to the urinary tract. Renal trauma is common and can be classified as either blunt or penetrative. Blunt trauma is far more common and includes road traffic accidents, falls, assault, sports. Penetrative trauma include stab and gunshots wounds. Symptoms are back pain, haematuria and possible haemodynamic instability. Diagnosis is based on contrast enhanced abdominal CT scans. Kidney injury scale includes 5 grades (Fig.3, Tab.12). Fig.3. Kidney injury scale Tab.12. Kidney injury scale Grade 1 – subcapsular hematoma without renal parenchyma laceration Grade 2 – perirenal hematoma, renal parenchyma laceration ≤ 1 cm Grade 3 – renal parenchyma laceration ≥ 1 cm Grade 4 – parenchymal laceration extending into urinary collecting system with urinary extravasation, active bleeding beyong Gerota fascia Grade 5 – renal artery or vein laceration, shattered kidney with active Bleeding. Grade 1-3 are usually treated conservativelly (most of all injuries), grade 4 and 5 require surgical intervention. Ureteral injuries are relatively rare but are often iatrogenic in origin. Delayed diagnosis of ureteral injury may lead to significant morbidity. Bladder injuries can be classified into either blunt or penetrative. Penetrative is most common iatrogenic (during transurethral resection of blader tumours or whilst performing intra-abdominal or pelvic operations – hysterectomy, Caesarean-section, bowel cancer surgery). High risk of bladder injury is in all pelvic fractures, seat belt injury and high impact falls. Bladder trauma is classified as intraperitoneal or extraperitoneal. Intraperitoneal is life threatening, symptoms are peritonism, abdominal distension, ileus, oliguria/anuria, haematuria or urethrorhagia. Retrograde cystography is the diagnostic gold standard for suspected bladder injury. Contrast enhanced CT scans of abdomen and pelvis confirm the diagnosis and treatment is often surgical. Urethral injuries commonly occur in association with pelvic trauma or straddle injuries. Blood at the urethral meatus is a classic sign of urethral injury. Retrograde urethrography should be performed before urethral catheterization when injury is suspected. Injuries of the male genitalia include trauma to the penis, scrotum, testes, and epididymis. Penile fracture is caused by rupture of the tunica albuginea of the corpus cavernosum. Immediate surgical repair is recommended in cases of penile fracture. Testicular trauma may result in contusion, rupture, or dislocation. Scrotal ultrasonography with Doppler is the imaging modality of choice for testicular injuries. Testicular rupture requires urgent surgical exploration. Genital injuries may be associated with significant psychological impact. Early recognition and prompt management are essential to preserve organ function. Associated injuries to other organ systems are common and must be assessed. Initial evaluation follows standard trauma protocols, including stabilization of the patient. Imaging plays a crucial role in the assessment of urological trauma. Conservative management is preferred when clinically appropriate. Surgical intervention is indicated in hemodynamically unstable patients or high-grade injuries. Long-term complications may include strictures, infertility, erectile dysfunction, and chronic pain. A multidisciplinary approach is often required for optimal management of urinary tract and genital injuries.

Courses

• Surgery 4 (Trauma Surgery, Urology) [ChK/CH-V4/09]