The Pattern, Management and Outcome of Genitourinary Trauma in Ghana

Abstract

Objectives: This is to review the pattern of causes, management and outcome of genitourinary(GU) injuries managed at the Korle Bu and the 37 Military Teaching Hospitals from 1978 to 2010.

Patients and Methods: Prospectively cases of genitourinary trauma from 1978 to 2010 were studied at the Korle Bu and 37 Military Teaching Hospitals. Patient history and clinical examination was taken and classified into haemodynamically stable or unstable condition. Stable patients were admitted and investigated whilst unstable patients were stabilised and operated. Investigations were based on the injuries sustained and included a full blood count , plain and contrast radiological investigations and computerised tomography .

Results: A total of 523 cases (460 cases from Korle Bu teaching hospital from 1978 to 2001 and 63 cases from 37 Military Hospital from 2001 to 2010) were managed made up of 412 males (78.8%) and 111 females (21.2%) with a male to female ratio of 4 to 1. The youngest was 4 years and the oldest was 64 years. Sites affected included 38 renal (7.3%), 63 ureteral (12.1%), 109 bladder (20.8%), 233 urethral (44.6%) and 54 external genital (10.3%). Causes included road traffic accidents (49.5%), industrial accidents (0.77%), falls (16.8%), high (1.15%) and low (2.7%) velocity injuries, bites (0.57%), iatrogenic (23.71%) and idiopathic (0.2%). Presentation included haematuria (80%), urinary retention (8%), anuria plus abdominal pain /peritonitis (10%) and 2% with peritonitis. Management was 57 (10.8%) conservative and 466 (89.2%) operative. Outcome was 462 (88.3%) recovery, 47 (8.9%) with complications and 14 (2.64%) deaths. 

Conclusion: Commonest causes of Genitourinary injuries in Ghana include Road traffic accidents 259(49.5%), Iatrogenic causes 124 (23.7%) and Falls 88 (16.8%). Early intervention in unstable patients prevents mortality .