Modern Trends in the Management of Urologic Trauma

Voiding and Sexual Dysfunctions after Pelvic Fracture Urethral Injuries Treated with either Initial Cystostomy and Delayed Urethroplasty or Immediate Primary Urethral Realignment

“…Advantages of this procedure are avoiding entry into the pelvic hematoma, with its associated risk of infection and excessive blood loss, and elective reconstruction of the urethral stricture using a mucosalto-mucosal anastomosis when the hematoma has resolved and the patient has recovered from associated severe injuries. On the other hand, primary urethral alignment immediately after trauma or in the early post-trauma period has also been proven effective in reestablishing urethral continuity and is highly effective in preventing secondary severe stricture formation (6,9). In addition, this approach eliminates the need for major reconstruction in the majority of patients, and avoids the long-term use of a suprapubic catheter after pelvic trauma.…”

“…Immediate management of pelvic fracture posterior urethral injuries remains controversial. Two methods are commonly used to treat pelvic fracture posterior urethral injuries (4)(5)(6). One of these methods is initial suprapubic diversion and delayed urethral repair, which is usually felt to be safer by the majority of urologists (1,6,7).…”

“…Two methods are commonly used to treat pelvic fracture posterior urethral injuries (4)(5)(6). One of these methods is initial suprapubic diversion and delayed urethral repair, which is usually felt to be safer by the majority of urologists (1,6,7). Second is primary urethral realignment immediately or within 10 days after the injury, which is thought to cause serious complications such as urethral stricture, erectile impotence and urinary incontinence (4,(8)(9)(10).…”

Segmental dearterialization in penetrating renal trauma

“…Severe haemorrhage, immediate or delayed, remains the most common cause of death in renal injuries, and constitutes the only definite indication for exploration of an injured kidney (Lucey et al, 1972). Knowledge of the segmental pattern of renal branch artery distribution as well as awareness that the branches are end-arteries can be applied to the treatment of haemorrhage due to low velocity penetrating trauma.…”

Life-Threatening Post-Nephrolithotomy Hemorrhage Resulting in Cessation of Kidney Function, Treated by Transcatheter Arterial Embolization with Subsequent Restoration of Excretory Function

“…Although life threatening massive renal hemorrhage not infrequently results in nephrectomy (8), there has been few reports of successful treatment by transcatheter arterial embolization (1--4, 12, 13). Such a case in which surgery was avoided and almost all the renal parenchyma was preserved is here reported.…”