- TNM Staging of Renal cell carcinoma (illustrated).

TNM Staging of Renal cell carcinoma.

Primary tumor (T):-

T0: No evidence of primary tumor
T1: Tumor 7 cm or less in the largest dimension, Tumor is confined to the kidney (i.e no penetration through the capsule).

- Renal trauma grading scale.

Basically we can divide renal trauma into five grades.

The grades I , II and III are classified as minor traumas, and the grades IV,V as major :-

• Grade I: contusion or subcapsular hematoma, without parenchymal laceration.
• Grade II: superficial cortical laceration less than 1 cm deep.
• Grade III: deep cortical laceration extending more than 1 cm.
• Grade IV:
1. corticomedullary laceration with collecting system injury and urinary extravasation. 
2.  vascular injury:- laceration or thrombosis of a segmental artery.

• Grade V:
1. Multiple deep lacerations.
2. Thrombosis of the main renal artery.
3. Avulsion of renal hilum which devascularizes kidney.

- Bladder Injury.

Bladder Injury

Aetiology:-

1. Blunt trauma : 10% of pelvic fractures.
2. Penetrating trauma :gunshots or stap wounds.
3. Iatrogenic:-
• Obestetric :- 0.3% with caeserean section.
• Gynaecological e.g.during a vaginal or abdominal hysterectomy.
• Urological e.g during cystescopy.
• Orthopaedic e.g. pins and screws can commonly perforate the urinary bladder, particularly during internal fixation of pelvic fractures.
4. Idiopathic:- due to presence of a previous scar.

Classification(Pathophysiology):-

1. Extraperitoneal rupture bladder:
Usually due to fracture pelvis,and Extravasation occur at the perivesical space and may extend up to the anterior abdominal wall,If the urogenital membrane is injuried.
2. Intraperitoneal rupture bladder:(The most dangerous)
Usually due to direct trauma when the bladder is full,associated with electrolyte disturbance and may passed unnoticed for along time.