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Journal of the Korean Society of Traumatology 2002;15(2):106-112.
Clinical Review of Lower Urinary Tract Injury
Min Hong Choa, M.D., Jun Seok Park, M.D., Dae Kon Sohn, M.D.,
Kwang Hyun Cho, M.D., and Hahn Shick Lee, M.D.
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
외상성 하부 요로 손상 환자의 임상적 고찰
좌민홍·손대곤·박준석·조광현·이한식
연세대학교 의과대학 응급의학교실
Abstract
Purpose
: We reviewed the clinical features of lower urinary tract injury patients for the purpose of early diagnosis and proper management. Methods : From January 1996 to December 2000, 45 patients with lower urinary tract injury were treated at our emergency department (ED). Among those patients, 31 patients were included and studied retrospectively based on medical records. Injuries of iatrogenic origins and patients who had been transferred after diagnosis outside the ED were excluded. Results : There were 16 patients with bladder injuries and 15 patients with urethral injuries. Their mean age was 39.7±19.0 (mean±SD), and 28 patients (90.3%) were male. The most common mechanism of bladder injury was motor vehicle accidents (62.6%) and that of urethral injury was falling (66.7%). The initial symptoms of bladder injury were gross hematuria (75.8%), abdominal pain( 50%), and voiding difficulty (12.5%), and those of urethral injury were blood at meatus (46.7%), gross hematuria (40%), and microscopic hematuria (13.3%). Anterior urethral injuries (76.3%) were more common than posterior injuries (26.7%), and incomplete rupture (53.4%) was more common then complete cupture. Six patients of complete rupture and 1 patient of incomplete rupture were treated with suprapubic cystostomy and the remaining patients were treated with foley catheterization. To evaluate the bladder injuries, we perpormed a retrograde cystography and/or an abdominal CT scan. All the patients with intraperitoneal bladder ruptures (11 cases) were treated with an emergency operation. The patients with extraperitoneal bladder ruptures were treated conservatively, except for 1 case of an operation. Conclusion: These findings, couple with clinical suspicion can help to diagnose the patients with lower urinary tract injury at the ED.
Key Words: Lower urinary tract; Injury; Bladder; Urethra


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