Urinary Tract Trauma

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Urinary Tract Trauma

• By Pretoria Hoyte

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Etiology

• Any patient with a history of traumatic injury
  should be assessed for involvement of the urinary
  tract.
• Trauma to the urinary tract often is associated
  with bladder trauma, or damage to the urethra,
  wounds to the lower abdomen, and anyone patient
  who has undergone abdominal surgery.

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Bladder Injury

• Injuries to the bladder can be divided into blunt
  trauma (such as a blow to the body) or
  penetrating wounds (such as bullet or stab
  wounds).
• Because the bladder is located within the bony
  structures of the pelvis, it is protected from
  most external forces. Injury may occur if there
  is a blow to the pelvis that is severe enough to
  break the bones and cause bone fragments to
  penetrate the bladder wall.

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Bladder injury due to pelvic fractures

• /

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Urethral Damage

• Urethrospasm (a spasm of the musculature of the
  urethra) urethrocutaneous fistula(a cutaneous
  fistula between the urethra and the skin) this
  occurs after repair of hypospadias or exstrophy
  of the bladder urethrocele (which is a
  herniation of the urethra in females)

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Herniation of the Urethra

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Clinical Manifestations

• Urine output should be monitored hourly for
  amount and color
• Any evidence of hemauria should be reported
• Pt. is assess for abdominal pain and tenderness
  (indicates hemorrhage, peritonitis)
• Difficulty voiding, flank pain

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Diagnostics

• An IVP (a radiographic technique for examining
  the structure function of the urinary system) may
  be needed.
• Urinalysis, KUB radiograph, excretory urogram,
  and

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Diagnostics cont.

• A cystoscopy may also be needed.

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Medical Management

• Surgical intervention will be necessary for
  correction of tears or rupture of the integrity
  of the urinary tract to reinstate urine flow
• This can be done with the removal of the kidney
  or bladder, with the creation of urinary
  diversion.

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Medical Managementcont.

• If the trauma is located in the kidney a
  nephrectomy (is the surgical removal of a kidney,
  performed to remove a tumor or otherwise diseased
  kidney) must be done.

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Medical Management cont.

• If the trauma occurs in the bladder a cystectomy
  (a surgical procedure in which all or part of the
  urinary bladder is removed) may be needed with
  urinary diversion.

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Nursing Interventions

• Nursing responsibility centers on identifying
  individuals at risk and detecting variations in
  assessment findings that indicate trauma to the
  urinary tract.

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Prognosis

• Prognosis depends on the extent and location of
  the trauma.