Урология - Trauma

Diagnostics

Anamnesis – trauma

Clinic – no urination, blood goes from uretra

In case of intraperitoneal lesion – tenesms, peritoneal symptoms, collaps

In case of extraperitoneal lesions – oedema at the pelvic area, reddish scin, tenderness at the down part of abdomen, pain in pelvis, scrotum

Instrumental methods

IVP – reveals urinary infiltration

US – blood clots, urinary infiltration, paravesical haematomas, empty bladder.

Rupture of a bladder neck at pelvic fracture. Bladder is moved upwards.

Intraperitoneal lesion of bladder. No normal contours of vesical bladder, Contrasting fluid is between intestines

Treatment

Treatment of shock

Conservative in case of contusion or slight tear

Bed regimen

Haemostatic therapy

Surgery in case of ruptures

Surgery

Intraperitoneal ruptures

Laparothomy, revision of peritoneal cavity

Suturing of bladder wound

Epicystostomy

Intraperitoneal

Extraperitoneal low-middle laparothomy

Suturing of wound

Anastomosis with uretra (if possible)

Catchment ( drainage)

Cystostomy

Traumas of Uretra

Diagnostics

Anamnesis

Clinic – uretrorraghia, urinary retention, desire to urinate, overwhelmed bladder, haematoma in perineum

Uretrography – revealing of urinary infiltratiom

Treatment

Treatment of shock

Conservative – in nonpenetrating wounds: bed regimen, ise-bottle, antibyotics, haemostatics.

Operative – cystostomy

Primary suture of uretra (in 24 -48) hours