Урология - Trauma
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Trauma
Mechanisms
Compresion between 11-12 rib and vertebral column
Hydrostatic blow
Flexion of kidney under influence of blow
Urine surface tension increasing
Iatrogenic traumas
Contributory factors
Age
Muscular tension
Thickness of paranephrium
Anomalia of kidney
Lesions
open closed
2. Ruptures of medullar layer non
closed penetrating the capsule
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Small ruptures of |
1.superficial |
2.subcapsular |
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cortical layer |
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non penetrating to |
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calyces and pelvis |
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3 ruptures |
4.Tearing off kidneyf |
4. Tearing off vessels and ureter.
3. Deep ruptures going from renal capsule to pelvis
Special place takes contusion of kidney. No macroscopic changes but it can
cause shock.
Posttraumatic diseases
hydronephrosis |
Nephrolithiasis |
Traumatic nephritis |
Aneurism of renal vessels |
Diagnostics
Anamnesis – trauma
Clinic – localised pain in lumbal area, swelling in lumbul area, haematuria, discharge of urine from the wound, protective muscular tension, shock.
Instrumental methods
Plain X-ray no border of psoas muscle
IVP – impairment of kidney function, outcome of contrasting fluid to the retroperitoneal space.
Ultrasound – lesion of renal capsule, intrarenal heamatomas, fluid in paranephrium.
Chromocystoscopy and retrograde pyelography ( not often)
Injury of a cortical layer of
kidney
Perforation of a |
Injury of a cortical layer of |
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pelvis retrograde |
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kidney |
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pyelography |
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Treatment
Treatment of shock
Conservative – at closed lesions of light and moderate severity
Bed regimen
Ice-bottle at lumbal area
Urgent operation in case of
Lesions of abdomen
Life-threatening bleeding
Open trauma
Postphoned operations:
At sudden impairment of general condition
Complications of trauma
The volume of operation is decided intraoperatively.