STRESS URINARY INCONTINENCE As described above, urethral support from the pelvic floor is essential for maintenance of continence during increases in intraabdominal pressure. In response to aging, multiple vaginal deliveries,…
OTHER FORMS OF URINARY INCONTINENCE Although not as prevalent as the forms of incontinence described previously, other mechanisms of urinary incontinence may occur. Fistulous communication between the bladder and the…
Penetrating bladder injuries mandate surgical exploration to assess for other intraabdominal injuries and to determine if there is damage to the ureters or trigone. To explore injuries, the bladder should…
PRESENTATION AND DIAGNOSIS Hematuria is a nearly universal feature of bladder rupture. Other signs include suprapubic tenderness, lower abdominal bruising, and low urine output. On laboratory assessment, patients may be…
TREATMENT In patients who are too unstable to undergo ureteral reconstruction, a “damage control” approach is appropriate. Two common strategies include bringing the ureter to the abdominal wall (temporary cutaneous…
An endoureterotomy consists of stricture incision under direct vision through a ureteroscope. Several different technologies can be employed, including cold knife incision, electrocautery, and holmium laser ablation. All require a…
The most common complications after renal trauma include prolonged urinary extravasation, delayed bleeding, arterial pseudoaneurysm, abscess, urinary fistula, and hydronephrosis. Renovascular hypertension may occur after renal trauma but is almost…
In stable patients, computed tomography (CT) with intravenous contrast is the imaging study of choice for demonstrating renal parenchymal injury, perirenal/ret-roperitoneal hematomas, urine extravasation, injuries to the renal hilum, and…
In older children and adults, undiagnosed congenital or acquired UPJ obstructions may cause intermittent, severe flank pain following increased fluid or diuretic intake. In addition, patients may experience hematuria after…
For large and/or complex stones, such as staghorn calculi (which occupy all or a large portion of the collecting system), a large endoscope is introduced percutaneously into the kidney through…
