It may result in high morbidity if not properly identified and managed. Current practices, as well as old and more recent controversies involving diagnostic and therapeutic approaches, are discussed. In children with multiple injuries, genitourinary tract trauma is second in frequency only to central nervous system trauma currarino et al. Blunt and penetrating abdominal trauma can cause significant injury to the genitourinary organs, and radiologic imaging plays a critical role both in. Most of these injuries, with the exception of renal hilar disruption or shattered kidney, are not immediately lifethreatening. Genitourinary trauma adrenal injury, attesting to the severity of the trauma. Pdf split and merge ihned zdarma ke stazeni slunecnice. Noniatrogenic ureteral injuries account for only about 1 to 3% of all genitourinary trauma. Genitourinary trauma and reconstruction team penn medicine. 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. Genitourinary system an overview sciencedirect topics. Genitourinary trauma, diagnostic evaluation of practice. These images are a random sampling from a bing search on the term genitourinary trauma. Genitourinary trauma and emergencies meir daller gennaro carpinito a urologic emergency arises when a condition requires rapid diagnosis and immediate treatment.
Eau guidelines on urological trauma request pdf researchgate. What is the mechanism of an anterior urethral injury at least 5 causes. Renal injury is common, occurring in 810% of cases of blunt and penetrating trauma. In children with genitourinary tract trauma, renal parenchymal. Chapter 35 abdominal and genitourinary trauma quizlet. Approximately 10 percent of patients suffering injuries severe enough to require admission to a trauma service sustain injury to the genitourinary tract. Click on the image or right click to open the source website in a new browser window. Most of these injuries, with the exception of renal hilar disruption or shattered kidney, are not immediately life threatening. Approximately 10% of trauma patients sustain injury to the genitourinary system. The diagnosis of genitourinary trauma typically relies on patient history, physical examination, urinalysis, and imaging ct, cystoscopy, retrograde urethrogram. Renalrenal traumatrauma causescauses penetrating injuriespenetrating injuries blunt traumablunt.
Ureteral trauma merck manuals professional edition. See initial management of trauma in adults and initial evaluation and management of blunt abdominal trauma in adults and pelvic trauma. The incidence of traumatic renal injury in the general population is reported to be around 4. Small size, mobility, protected location 1% of all urinary tract trauma. Identification of these injuries is essential as they can be overlooked in the setting of multitrauma. Because trauma is a multisystem disease, multiple injuries may be present in the trauma patient.
Christopher digiacomo, md, nassau university medical. Screening for blunt cerebrovascular injury bcvi admission criteria. The lower tract consists of the bladder and the posterior portion of the urethra. They usually result from gunshot wounds and rarely from stab wounds. Genitourinary trauma knowledge for medical students and. Genitourinary trauma trauma, 8e accesssurgery mcgraw.
Traumatic injuries of kidney and ureter bladder injuries. Trauma genitourinary free download as powerpoint presentation. Paediatric trauma is addressed in the eau paediatric urology guidelines. 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. Genital mutilation of women by removing the clitoris, which is done in some cultures, is a form of genital trauma and child abuse. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Chapter 47 genitourinary trauma episode overview 1.
Because they are often accompanied by potentially lifethreatening injuries to other organ systems, it is easy for the emergency physician to overlook. Trauma to different areas of the gu tract can be caused in a variety of ways, and the diagnostics and management of the injuries vary widely depending on the mechanism and location. The european association of urology eau guidelines group for urological trauma prepared these guidelines in order to assist medical professionals in the management of urological trauma in adults. This chapter focuses on traumatic and nontraumatic genitourinary gu emergencies typically arising in the emergency department, outpatient clinic, or inpatient ward. Genitourinary trauma is a common finding in the patient with multitrauma, and includes injuries to the kidneys, bladder, ureters, urethra, penis, and scrotum. This article describes the care of the patient with genitourinary trauma focusing on assessments, diagnostic. Genitourinary trauma gut injuries associated trauma to chest, abdomen and pelvis. Request pdf eau guidelines on urological trauma to determine the optimal evaluation. In particular, pelvic fractures may be the source of major hemorrhage. Trauma is the most common cause of morbidity and mortality in the pediatric population beyond 1 year of age stein et al. 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.
Stat interventional radiology consult ir stat trauma clinical practice policy. Injury to the genitourinary gu tract occurs in up to 10% of all traumas, with the kidneys being the most frequently affected. Genitourinary injuries references advanced trauma life support for doctors, atls student course manual, 8th ed. Severe genital injuries occur most commonly on the battlefield because of the ground explosives commonly used. Chapter 36 abdominal and genitourinary trauma flashcards.
Start studying chapter 36 abdominal and genitourinary trauma. It begins by providing a brief explanation of databases that have been recently used to study this patient population, then proceeds to discuss each genitourinary organ individually, discussing the most relevant and up to date information published for each one. To determine the optimal evaluation and management of genitourinary renal, ureteral. Combining mri and clinical parameters for pc prediction. New methods of management, including laparoscopic techniques, complement and, in some cases, supplant traditional techniques. In children with genitourinary tract trauma, renal parenchymal lesions are the most prevalent injuries. 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.
Imaging plays a crucial role in the evaluation of the genitourinary tract in a patient who has suffered either blunt or penetrating trauma because multiorgan injury is common in such patients. Knowledge of genitourinary system anatomy is essential to evaluating and treating traumatic urologic injuries. Pdfmerge je uzitecna pomucka pro spojovani nekollika pdf souboru do. Trauma may result from a variety of causes, including motor vehicle accidents, falls or sports injuries. Contrastenhanced ct is the primary imaging technique used to evaluate the upper and lower urinary tract for trauma. What is the mechanism of an anterior urethral injury at least 5. Genitourinary injuries occur in 1020% of major trauma patients.
Genitourinary trauma involves injury to the kidneys, ureters, bladder, andor urethra. Genitourinary trauma and reconstruction program penn. 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. The close cooperation between radiologists and urologists is essential for the most effective management of genitourinary trauma. This article describes the care of the patient with genitourinary trauma focusing on assessments, diagnostic testing, and patient care. Injury to the genitourinary system is overall uncommon, with an estimated incidence of 95% of bladder ruptures caused by blunt trauma.
This episode helps delineate what to look for and what not to miss when considering gu trauma. In children, avulsion injuries are more common and occur at the ureteropelvic junction. In children who sustain multiple injuries, urinary tract trauma is second only to trauma to the central nervous system. Damage to the kidney represents the most common type of urinary tract injury. 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. Most pediatric trauma is associated with vehicular and pedestrian accidents. This is a pdf file of an unedited manuscript that has. Timely identification and management of genitourinary injuries can minimize the associated morbidity, which may include impairment of urinary continence and sexual function.
Renal injuriesrenal injuries ureteral injuries bladder injury urethral injuries 3. The majority of these injuries approximately 80% are the result of a blunt trauma mechanism. Of the traumatic injuries patients hospitalized in the united states each year, 10% are found to have genitourinary injuries. Mohamed shafikurology department alexandria university 2. In newton c, khare r, editors, emergency medicine quick glance. 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. Other injuries often take priority over injuries to the genitourinary gu system and may initially interfere or postpone a complete urologic assessment. Because they are often accompanied by potentially lifethreatening injuries to other organ systems, however, it is easy for the emergency physician to.
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