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Slide 1 :
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Bladder Trauma Seen in 15% of all pelvic fractures
Intraperitoneal or extraperitoneal
History of lower abdominal trauma
Injury during pelvic surgery |
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Slide 2 :
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Pathophysiology Clinical Presentation Pelvic fracture Hematuria Bleeding into
bladder cavity Penetrating injury to lower abdomen Blunt trauma to lower abdomen Urine spillage Urine peritonitis Nausea
Vomiting
Fever
Abdominal distention
Abdominal pain
Abdominal tenderness Poor urine output Shearing injury Bladder rupture Wound
Contusion
Hematoma Laceration of bladder |
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Slide 3 :
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Management Diagnostic :
Stress cystogram
Therapeutic :
Prompt surgical closure of the bladder (for intraperitoneal extravasation)
Catheterization (for extraperitoneal extravasation from blunt trauma)
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Slide 4 :
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Urethral Trauma Posterior
Prostatic
Membranous
Anterior
Bulbous
Penile |
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Slide 5 :
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Mechanisms of Injury Blunt trauma
Direct trauma to the perineal area
Straddle injury
Pelvic fracture
Penetrating injury
Improper urethral catheterization |
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Slide 6 :
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Clinical Presentation Blood at urethral meatus
Inability to urinate
Suprapubic mass
Perineal hematoma
Wound to the perineum or penis |
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Slide 7 :
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Diagnostics Retrograde urethrogram
Extravasation of dye
Failure of the dye to fill the bladder |
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Slide 8 :
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Management Immediate surgical repair
Diversion : suprapubic cystostomy
Catheterization under direct vision, guided by a urethrocystoscope |
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Slide 9 :
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Anuria Failure to produce urine to expel
Pathophysiology :
Renal failure
Complete, obstruction of the upper urinary tracts (bilateral)
Obstruction by stones
Ureteral compression by tumor / enlarged retroperitoneal nodes
Retroperitoneal fibrosis compressing the ureters
Ureteral stricture |
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Slide 10 :
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Management Emergency hemodialysis
Urinary diversion :
Tube nephrostomy
Ureteral stenting
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