Genitourinaria injury occurred approximately 10-15% of patients with abdominal and pelvic injuries. Damage to the external genitalia are rare. When genital trauma occurs, consider the urethral injury is important. The correct diagnosis and treatment of genital trauma beyond the purpose of maintaining the structure and function of organs and complications such as infection, bleeding, and urinary flow. General, an adequate blood supply to the external genital provide healing and prevent infection. In the case of genital trauma and loss of important institutions may, the possibility for the occurrence of emotional pain need to immediately consult a psychiatrist. (1)
A urine gravity arises in situations where a quick diagnosis and immediate treatment. Damage genitourinary organs are generally not immediately life threatening. However, if not properly assess and treat the injury can cause long-term morbidity of patients. Advances in special care and X-ray image is improved diagnosis and survival in serious injury. It is the responsibility of the urinary tract to explain accurate picture of the urinary tract and surgical intervention to provide if needed. (2)

B. General principles of trauma management
Approximately 10% of genitourinary injuries of fatalities, but only 2% of road-related urogenital special. Urogenital system can be divided into three sections, each with its own damage. Channel arteries including adrenal, kidney and ureter. Bottom channel including bladder, prostate and urethra climate. First section includes external urethral, penis, scrotum,
and testes in men. Trauma patients to the ER can have (a) signs is important in stabilizing the needs of the interventions, (b) down after stabbing injury with significant signs of stability, or (c) blunt trauma with signs of stability is important. (2)

C. Anamnesis History
Trying to get a detailed history of the patient's injury or witnesses. Loss of consciousness is a strong sign of the injury and was forced to head to the injury. In the case of patient falls, high falls and the surface of the victim, where the patient falls is important. The car accidents, vehicle speed, location of the victims in the vehicle and seat belt use is important. The gunshot wounds, weapons, and launch the Caliber and the distance of the victim was shot can be used to the extent of tissue damage estimate. (2)

D. Physical examination
Progress during the evaluation of trauma as a whole. Hemodynamic disorders requiring active resuscitation and urgent surgical exploration in most cases. The findings of physical pain, or ekimosis stab wounds in the pelvis, suprapubis region, pelvic or genital outside indicated a strong potential urological trauma. Pelvic Instability gives a pelvic fracture and should be alert to the risk of injury to the bladder or urethra. As above, much blood on the urethral meatus, and transformation of the superior rectal inspection also found that prostatic urethral injury. (2)

E. Diagnostic tests
Start with hematuria urinalisa usual to see and should be performed on all patients. Urethritis should dikateter is injury uncertain. If the blood of the urethral meatus or encounter a major pelvic fracture, urethral injury should be removed from power ureterografi Retrograde. (2)

F. Check radiation
1. Plain abdominal
Can see a trace of pelvic fracture, rib, or vertebrae. The loss of perirenal road, take psoas shadow, or the presence of intestinal gas changes can indicate a retroperitoneal hematoma or urinoma. A picture of ground glass "on the plain could be due to intraperitoneal ekstravasasi urine. (2)

2. Uretrogram Retrograde
Only if urethral injury is suspected by the presence of blood in the ear, the higher the conversion denan rectal prostate exam finger, broken pelvis, or inability to install pipes urethra. Research can be done easily by Brodney clamp may be entered into the glans penis or the size 12F Foley catheter was introduced into navikulare fossa. Balloon was developed just enough to keep the catheter in place. After the patient is placed in a 30-degree oblique position, 15 ml of Radiographic contrast material is injected slowly. Ekstravasasi indicate the existence of urethral injury. Post-urethral part of the wall in the back bowls uretrografi confusing, because the sphincter often closed out. (2)

3. Sistografi
Indicated to exclude bladder injury in all patients with blunt or sharp trauma or haematuria mikroskopus total picture. In patients with stab wounds no hematuria, sistografi instructions depending on the nature and location of the wound. Ideally should be done in the radiology room with a capacity sistografi fluoroscopy to a picture of real-time acquisition and bevelled. Some places have Sisto g CT (computer tomography) as a selection study. Without ignoring the techniques used, it is important to fill the bladder with a substance kontas evidence ekstravasasi a small amount. Ekstravasasi the bladder can not be detected by intravenous urogram (IVU) or CT-scan as inkomplit bladder removal. Allow agents to flow back through the catheter by gravity to a full bladder and at least 250 ml, is generally required. Once the bladder emptied, a postvoid film is important to see the bladder ekstravasasi. (2)

4. CT with intravenous contrast agents
Has become a gold standard "of the evaluation of trauma research and treatment, preferably in trauma. Scans spiral (helix) can be done in time <5 minutes and provides an excellent assessment of the integrity of renal parenchymal disease, injury to abdominal organs, and hematoma or urinoma. CT can demonstrate that both renal function and excretion. (2) 5. IVU no longer recommended for filtering pasieng suspected kidney damage. IVU may be useful in patients with traumatic theme turia without CT. The case of unstable patients, a kidney shot IVU is useful for exploration to the collateral. Sehelah Accepted scout film, the contrast agent (Renografin-60 doses of 1 ml / kg) administered intravenously for 3-5 menint. A film on 5 -10 minutes after contrast material injection. full picture of the kidneys can not get IVU, although patients with a systolic blood pressure> 90 mmHg. (2)

6. Renal arteriography
Can be included on the state of the renal vascular injury, the diagnosis is made by not looking at the CT or IVU. In some patients it is important to determine continued bleeding suber, adding kidney damage. If the cause of the bleeding is known to clear arteriografi embolization can be done immediately. (2)

7. Ultrasound
He did not allow invasive evaluation and subkapsular perirenal hematoma and is useful in patients treated cramoplasty kidney damage. (2)

8. Research Radionukleotida
Useful in monitoring the treatment of patients with injuries occur in hypertension. (2)

G. Female genital lesions
Penile trauma and emergency situations
1. Penis injury
Can be done by shooting wounds, stab wounds, machinery accidents, animal attacks and mutilation. Wounds in the penis are treated with debridement, hemostasis, and repair of damaged tissue with antibiotic therapy. Accident machine can produce partial or total separation of the genital skin. Some injuries require careful debridement and skin grafting. Urethral continuity can be assessed by uretrografi Retrograde. (2)

2. Penis spontaneous rupture
May occur during intercourse and korpora to break the tunica albuginea. Penile fracture usually occurs in young men (age 30 years). Signs and symptoms of clinical fractures, including the penis is a sudden sharp pain, swelling, ekimosis, blood from the urethra, the penis deviation in the opposite case of blood-injury, and d. spontaneous erection during intercourse. Penile fracture can appear anywhere on the shaft of the penis or occur at the base of the penis. Preview the latest from the penis fracture can mimic Peyronie disease. Urethral injury may occur simultaneously and should be removed using uretrogram back. (2)
Sexual trauma such as broken or crushed testicles of urethritis or ligaments of the penis. Penis ligament injury can be found in angulasi unusual deviation, or dislocations, or the penis can not grow. Many cases of penile fracture surgical exploration should clean up the network, hematoma grew up and close the defect in tunica albuginea. Incision of the body represented Corporal eversion penoskrotal access vulnerability. (2)

3. Vascular injury penis
Sexual trauma in the superficial dorsal penile vein can lead to venous thrombosis and the presence of pain during erection, ekimosis and terabanya venous thrombosis on the dorsal surface of the penis. Break in the dorsal penile vein can mimic penile fracture. Lymphangitis trauma after sexual intercourse, a nodular coronal sulcus, stress, and circumferential swelling. Patients do koagulapati so many fragile blood vessels in the penis. Frenular ruptured artery may occur during intercourse. For patients with an infusion frenulum artery, the artery should be tied to work, and if appropriate circumcision performed. (2)

Injury to scrotum are relatively rare. Peak rates occurred between the ages of 10-30 years. Shame associated with trauma or mechanisms often leads to the clinical picture of late. Physical examination should assess the integrity of the corporal and found blood in the ear that may indicate urethral injury. Uretrografi back implementation if urethral injury is suspected. Color Doppler image of the testis should be performed to assess the integrity of the blood supply and to make the tunic of the testis close.
Injuries to the scrotum and its contents can lead to infertility, chronic pain, hypogonadism, and behavior of a person. (2.3)
1. Treatment with antibiotics
The injury occurred in this area (eg agriculture, hunting, military activities) and should be treated with clindamycin (900 mg IV / IM every 8 hours) and penicillin (nafsilin 1 to 2 grams IV every 4 hours) to to prevent tetanus and klostridium perfringens. Coronation of an animal bite to Pasteurella multocida and Streptococcus sp. Selected antibiotic Amoxicillin / klavulanat (2 x 500-875 mg per day).
2. Treatment
• Avulsion scrotum treated with debridement and primary closure with sutures can be absorbed. Vaskularitas and elasticity of the scrotum to close a defect is relatively large. To complete the scrotal skin graft.
• blunt scrotal trauma usually involves damage to the testes. Testicular space may occur in blunt trauma and is an approach to the groin line spermatikus pengendaluan. Testicular tumor can be seen with scrotal bleeding after a minor injury.
• An injury at low velocity bullet and stab wounds to the scrotum require exploration work to determine the ability of the testis. Low-speed bullet is a high risk for vascular thrombosis and loss of tissue. Skin should be cleaned and used sewer. With a slow necrosis, debridement and wound care is both important. (2)
Testicular trauma
Testicular trauma usually occurs in young men, usually 15-40 years. Blunt trauma accounts for 85% of cases. The cause of blunt trauma are the most common sports injuries, followed by a kick in the groin. Rare etiology of blunt testicular trauma is motor vehicle accidents, falls from height, and straddle trucks injuries. The cause of testicular injury in a gunshot wound. Severe blunt injury to the testicles can cause broken testicle. Testis can be broken spontaneously or with trauma as few other disorders, especially cancer. After the break the tunica albuginea, with bleeding into the space around the testis must be considered, which causes hematoma. (2)

1. Diagnostic testicular damage
Patients often come with a history of blunt scrotal Truma clear and often associated with nausea and vomiting. For deep wounds, the wounds of entry and exit gunshot wounds. Check carefully the contralateral, perineum, rectum, and femoral arteries. Day can be found painful, swollen scrotum is transilluminate. Scrotum or perineal Ekimosis can be found. (2)

2. Testicular trauma treatment
Depending on the extent of damage and hematoma Tinga Katan. Once the damage has little or no, should arouse suspicion of malignancy, and patients who test testicle through the groin exploration. Patients with severe trauma and bleeding underwent scrotal exploration and repair of the testes. Where possible, the testicles crushed orchiektomi process. Patients with a history Truma hematoma was less clear but may be treated conservatively with increasing pain, the scrotum is cold and compression. (2)

Loss of Penis and Scrotum Skin
Areas of the body skin Avulsion associated with a large wound, soft tissue damage. Occupational accidents with tools or farm machinery, industrial, or falls off a motorcycle or bicycle can Avulsion skin of the penis and scrotum.
Other causes of infection, such as Fournier gangrene, burns, wounds and fire. (4.5)

Clinical picture
Avulsion skin can be released by the total or still a part of the tribe. New on the genitals caused by water, fire, electricity or chemicals, the degree burns occurred Tuesday destroyed all of the skin. Wounded by gunshot wounds to the genitals is often extended, and is associated with damage to the environment. (4)

Diagnosis of the genital area skin loss is not difficult, it is important to determine the cause, along with the Rx. (4)

If no skin is to spur dihubungankan Avulsion or after washing the wound and debridement, the skin can be used to close defects. If the skin Avulsion off the total, making debridement, excision and skin tandur. When burned by hot water or fire, as grade I or II, the wound healed with treatment in place. Tuesday extent necessary debridement, excision and skin tandur. Electrical burns usually caused by damage to the skin so it is recommended conservative debridement can be defined to limit remains important.
Chemical burns rarely found. Initially treated with irrigation water. In some cases, debridement be done to prevent the destruction of a broader and deeper. Then perform wound care until the deficiencies are ready to close. (4)

H. Damage outside female genital
Direct trauma from the accident of genital rare. The damage and torture and rape should be regarded as a particular aspect of the physical, psychological, legal and criminal justice. Genital examination in patients with torture or rape often must be done in general anesthesia. (4)

1. Perineum break.
Perineum is often broken by trauma at birth. Perineum break divided into three levels:
• Level 1 to just tear the vaginal mucous membranes and skin of the perineum.
• Level 2 with a tear in the mucous membranes, skin and perineal muscles, except the anal sphincter.
• Level 3 with damage to the anal sphincter and rectal wall can relax.
Cutting rates is 3 complete break, while levels 1 and 2 is called the perineum inkomplit break. (4)

Diagnosis of the perineum broken is the control test. Although anal seems intact, the diagnosis is determined by rectal examination. (4)

Broken perineum does not require a computer degree. Two-level break if not selected will not create alvus incontinence, but probably is uterine prolapse or vaginal prolapse. Therefore, the proportion of dead to stabbing 2 layer by layer are again very carefully after a local anesthetic. Muscles must be sewn to prevent downtime and abscess, and pelvic floor is the strength of the whole again. Noting that the stabbing is not pulled too tight, because it will lead to a UdeM cause tremendous pain for several days. (4)
Perineal level 3 broken Sewing requires a special technique that is important to find the back sphincter ani externus musculus sphincter constantly repaired. Then pelvic floor rehabilitation. (4.6)

2. Fistula
Urinary fistula severe pain, because the urine constantly without stopping, which causes noticeable odor, and patients should always wet relate to human relationships. Distribution fistula also cause similar problems. (4)
Fistula between vagina and urinary tract (uretrovaginal fistula, or fistula vesikovaginal fistula ureterovaginal) or gastro-intestinal (fistula rektrovaginal) rarely caused by direct trauma. Obstetric fistula is usually caused by trauma, surgery on a malignant disease or radiation. (4)
Obstetric trauma work is often long, so the fetal head hit the road too long to employees arising from tissue ischemia and death. Fistula became obvious after a few days, the cells die, a hole or off. (4)
Each operation in the pelvic area can cause complications in the form of a fistula. Malignancy and necrosis, which can lead to bertukak fistula. Fistula unusual pascaradiasi considered after several weeks to several months. (4)
The most common fistula vesikovaginal often caused by a difficult birth. Fistula number rektovaginal into two. Fistula usually caused by squeezing the head of the fetus to the Cape and os sacrum. Fistula common and generally uretrovaginal a fistula vesikovaginal expansion.
Fistula and rare vesikouterin often found in post-sesaria seksio surgery. Usually this is in error fistula unconscious. (4)
Fistula enterovaginal rare. Occurred between the ileum and vagina, while fistula urethra and vagina is rare.
The diagnosis of genital fistula can be performed based on history and symptoms of urinary incontinence or distributed through the vagina. Location and size can be determined by direct inspection doors fistula, contact the Speculum, cystoscopy, or rektoskopi. Fistula is sometimes difficult to see, to go with green metilene inserted bladder. (4)
Management. Fistula new post-post-childbirth or surgery can not be immediately resolved, but only delayed at least 3 months of the members have the opportunity to surrounding normal tissues KAMBALI. Surgery is usually done through the vagina and require experience and special skills. (4)

Most agencies surgery urogenitalia
peritonium more room house, and is protected by muscles and other organs. So, if obtained urogenitalia organ damage,
also considered the possibility of hurting other agencies
around. (6)
The concept of brand damage to the urinary tract is often not diagnosed or diagnosed too late for the attention of the helper is usually carried out by injury, trauma in the body and limbs only, this delay may cause serious complications such as bleeding and peritonitis, and therefore any accidental damage to the urinary tract have not suspected until proven guilty. Urinary tract injury often not just about the only one body, so the entire urinary system is always treated as a single entity. Also note that the general conditions and important signals should always be repaired / maintained, before a more specific treatment.
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