He began his discussion with ureteral trauma noting that trauma from an external injury is rare (4%) but that it can often be a penetrating injury. Blunt trauma occurs in 1% of cases. A penetrating injury is often missed but can be diagnosed using methylene blue test or a CT scan. Repairs involve the use of stents with watertight closure. 32% of repairs are ureterostomies. At least 20% of caesarean sections injure the ureter, and injury also seen with tubal ligation. Only 20% of these injuries are dissevered intra-operatively so there is a delayed diagnosis, and only a small number of patients will have hematuria with an injury to the ureters. These patients ususally require an open repair. Stents may or may not be helpful, and all patients should be informed of complications.
The lecture went on to describe testes injury or trauma. If it occurs from blunt trauma, then 50% will rupture. Blunt trauma is seen in sports. An ultrasound may be helpful in making a diagnosis. Testicular trauma is also caused by gunshot wounds (2%) and these men need to have surgery to try to save the testicles. There are associated injuries with these including thigh injury (75%) that may involve the femoral artery and penile (37%) and perineum injuries (25%). Dr. Santucci ended his lecture discussing penile trauma which is often caused by self-mutilation where the man amputates his penis. 87% of these cases occur in acutely psychotic men. If the penis is cut off, it should immediately be placed in water and on ice until re-attachment can occur.
[refs: Ho YM, Schuetz M. Grade 4 renal injury: current trend of management and future directions.Chin J Traumatol. 2011 Apr 1;14(2):120-2
Santucci RA, Wessells H, Bartsch G, et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. Br J Urol. 2004; 93(7):937-954.
Tonkin JB, Tisdale BE, Jordan GH. Assessment and initial management of urologic trauma. Med Clin North Am. 2011 Jan;95(1):245-51.]
Presented by Richard A Santucci at the Society for Urodynamics and Female Urology (SUFU) 2011 Winter Meeting - March 1 - 5, 2011 - Arizona Biltmore, Phoenix, Arizona, USA
Reported for UroToday by Diane K. Newman, RNC, MSN, CRNP, FAAN and Continence Nurse Practitioner Specialist - University of Pennsylvania Medical Center.
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