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Urology > 1(E): Urinary Tract Trauma > Flashcards

1(E): Urinary Tract Trauma Flashcards

1
Q

What is the main cause of kidney trauma

A

Blunt abdominal trauma (80%)

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2
Q

What are two causes of blunt abdominal trauma

A
  • RTA: acceleration-deceleration

- Fall from height

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3
Q

Aside from blunt abdominal trauma, what may cause injury to the kidneys

A

Blunt thoracic trauma: fracture rib 9-12

Penetrating trauma

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4
Q

What are the features of renal trauma

A

Haematuria
Flank pain
Shock

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5
Q

What is a sign of renal trauma

A

Grey-Turner sign

- Retroperitoneal haemorrhage

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6
Q

How should all trauma be investigated

A

ATLS approach

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7
Q

Outline ATLS approach

A

Primary Survey:
- C A-E
= looks for injuries that may require resucitation

Secondary Survey:
- Looks for other injuries (History and Exam)

Definitive Survey:
- Looks for specific injuries and radiological imaging

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8
Q

If a patient with renal trauma is haemodynamically unstable what is first-line investigation

A

On-table intravenous urogram

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9
Q

Why is an in theatre on table intravenous urogram performed

A

As patient may require nephrectomy

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10
Q

What can an intravenous urogram also be called

A

Intravenous pyelogram

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11
Q

Explain intravenous urogram (pyelogram)

A

Contrast is injected IV - drains through kidney and urological system. Then series of X-rays are taken

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12
Q

If a patient is haemodynamically stable with suspected renal trauma, what investigation is ordered

A

CT CAP

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13
Q

How are renal injuries graded on CT

A

AAST

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14
Q

What is AAST Grade I

A

Contusion

Sub-capsular heaematoma

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15
Q

What is AAST Grade II

A

<1cm parenchymal lesion

  • No extravasion of urine
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16
Q

What is AAST Grade III

A

> 1cm parenchymal lesion

  • No extravasion of urine
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17
Q

What is AAST Grade IV

A

Parenchymal lesion involving medulla/cortex/collecting system - causing extravasion of urine

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18
Q

What is AAST Grade V

A

Shattered kidney of avulsion of the hilum

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19
Q

How is 95% of renal tract trauma managed

A

Conservatively

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20
Q

What is indicated if expanding retroperitoneal haematoma, Hb <70 or patient is in shock

A

Embolisation and surgical exploration

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21
Q

What are the two cause of ureteral injury

A
  1. Internal

2. External

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22
Q

What causes internal ureteral injury

A

Surgery:

  • Hysterectomy
  • Colectomy
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23
Q

Explain anatomical structures in relation to ureters and how this may lead to damage in surgery

A

Females:

  • When ureters enter the pelvis that pass from lateral to medial and therefore adjacent to ovaries. Therefore during oophorectomy there is risk of damage when ligating ovarian arteries
  • The ureters also pass under the uterine arteries (water under the bridge) meaning there is risk of damage during hysterectomy

Males:
- Ureters pass under vas deferens and therefore risk of damage during sterilisation

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24
Q

What can cause external ureteral injury

A
  • RTA

- Penetrating trauma

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25
Q

Why is external ureteral injury rare

A

As ureters are mobile

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26
Q

How can internal ureteral injury present

A
  • Ileus
  • Prolonged post-op fever
  • Persistent drainage from wounds
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27
Q

How does external ureteral injury present

A
  • Flank pain
  • Peritonitis
  • Abdominal mass (Urinoma)
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28
Q

If external post-operative ureteral injury, how is it investigated

A

Intravenous urogram

Or, retrograde urogram

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29
Q

How is ureteric injury managed

A
  • JJ Stent
  • Psoas hitch
  • Ureterostomy
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30
Q

What is a JJ Stent

A

Tube placed in ureter for 3-4W heal by primary intention

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31
Q

What is a psoas hitch

A

Bladder is attached to the psoas to lift it up in the pelvis - if urter shortened

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32
Q

What is a uterostomy

A

Damaged ureter is attached to the other ureter

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33
Q

How is an infected urinoma managed

A

IV Antibiotics
Percutaneous Nephrostomy
Delayed repair

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34
Q

What trauma can cause bladder trauma

A
  • Blunt abdominal trauma (If Full)
  • Penetrating abdominal trauma
  • Pelvic fracture
  • Surgical procedures: TURBT, TURP, C-Section
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35
Q

What are the two types of bladder injury

A
  1. Intraperitoneal = double fold of peritoneal membrane covering the bladder is damaged causing urine to leak into peritoneum
  2. Extra-peritoneal = peritoneum is intact
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36
Q

What is the triad of symptoms in bladder injury

A

Suprapubic pain
Inability to void
Haematuria

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37
Q

What are two others features of bladder injury

A

Ileus (if intraperitoneal)

Abdominal distention - due to urine

38
Q

How is bladder injury investigated

A

Retrograde cystography

39
Q

Of the types of bladder injury, which is more severe

A

Intraperitoneal

40
Q

How is intraperitoneal bladder injury managed

A

Surgically

41
Q

How is extraperitoneal bladder injury managed

A

Conservatively - catheterise for 2W and then retrograde cystography to assess if healed

42
Q

How are urethral injuries divided

A

Anterior and Posterior

43
Q

What is the anterior urethra in males

A

Spongy urethra and Bulbar urethra

44
Q

What is the anterior urethra in females

A

Distal 1/3

45
Q

What is the posterior urethra in males

A

Prostatic and membranous urethra

46
Q

What is the posterior urethra in females

A

Proximal 2/3

47
Q

What urethral injuries is rare in females

A

As female urethra is short and poorly attached to the pelvis meaning it is rarely damaged in pelvic fractures

48
Q

What is the main cause of anterior urethral injuries

A

Straddle injuries

49
Q

What are 3 other causes of anterior urethral injuries

A

Penetrating

Insertion
Catheters - inflating balloon
Penile surgery

50
Q

What causes posterior urethral injuries

A

Pelvic Fractures

51
Q

What are 2 other causes of posterior urethral injuries

A

TURP

Prolonged Injury

52
Q

In which gender are posterior urethral injuries rare

53
Q

How do anterior urethral injuries present clinically

A
  • Haematuria
  • Inability to void
  • Butterfly bruising
54
Q

What causes butterfly bruising

A

Disruption of buck’s fascia = enables blood to track into the scrotum

55
Q

What is Buck’s fascia

A

Deep layer of superficial fascia covering the penis

56
Q

How do posterior urethral injuries present clinically

A

Haematuria
Inability to void
Per-anal bruising
High-riding prostate

57
Q

What causes a high riding prostate

A

Blood collects in retropubic space causing prostate to rise

58
Q

How are urethral injuries investigated

A

Retrograde urethrogram

59
Q

How are partial anterior urethral injuries managed

A
  • Suprapubic catheter
  • Antibiotics
  • Retrograde urethrogram in 2W to assess healing
60
Q

How are complete anterior urethral injuries managed

A
  • Surgical repair
61
Q

How are posterior urethral injuries managed

A
  • Suprapubic catheter and delayed urethroplasty
62
Q

What is a complication of urethral injury

A

Urethral stricture

63
Q

What trauma can cause bladder trauma

A
  • Blunt abdominal trauma (If Full)
  • Penetrating abdominal trauma
  • Pelvic fracture
  • Surgical procedures: TURBT, TURP, C-Section
64
Q

What are the two types of bladder injury

A
  1. Intraperitoneal = double fold of peritoneal membrane covering the bladder is damaged causing urine to leak into peritoneum
  2. Extra-peritoneal = peritoneum is intact
65
Q

What is the triad of symptoms in bladder injury

A

Suprapubic pain
Inability to void
Haematuria

66
Q

What are two others features of bladder injury

A

Ileus (if intraperitoneal)

Abdominal distention - due to urine

67
Q

How is bladder injury investigated

A

Retrograde cystography

68
Q

Of the types of bladder injury, which is more severe

A

Intraperitoneal

69
Q

How is intraperitoneal bladder injury managed

A

Surgically

70
Q

How is extraperitoneal bladder injury managed

A

Conservatively - catheterise for 2W and then retrograde cystography to assess if healed

71
Q

How are urethral injuries divided

A

Anterior and Posterior

72
Q

What is the anterior urethra in males

A

Spongy urethra and Bulbar urethra

73
Q

What is the anterior urethra in females

A

Distal 1/3

74
Q

What is the posterior urethra in males

A

Prostatic and membranous urethra

75
Q

What is the posterior urethra in females

A

Proximal 2/3

76
Q

What urethral injuries is rare in females

A

As female urethra is short and poorly attached to the pelvis meaning it is rarely damaged in pelvic fractures

77
Q

What is the main cause of anterior urethral injuries

A

Straddle injuries

78
Q

What are 3 other causes of anterior urethral injuries

A

Penetrating

Insertion
Catheters - inflating balloon
Penile surgery

79
Q

What causes posterior urethral injuries

A

Pelvic Fractures

80
Q

What are 2 other causes of posterior urethral injuries

A

TURP

Prolonged Injury

81
Q

In which gender are posterior urethral injuries rare

82
Q

How do anterior urethral injuries present clinically

A
  • Haematuria
  • Inability to void
  • Butterfly bruising
83
Q

What causes butterfly bruising

A

Disruption of buck’s fascia = enables blood to track into the scrotum

84
Q

What is Buck’s fascia

A

Deep layer of superficial fascia covering the penis

85
Q

How do posterior urethral injuries present clinically

A

Haematuria
Inability to void
Per-anal bruising
High-riding prostate

86
Q

What causes a high riding prostate

A

Blood collects in retropubic space causing prostate to rise

87
Q

How are urethral injuries investigated

A

Retrograde urethrogram

88
Q

How are partial anterior urethral injuries managed

A
  • Suprapubic catheter
  • Antibiotics
  • Retrograde urethrogram in 2W to assess healing
89
Q

How are complete anterior urethral injuries managed

A
  • Surgical repair
90
Q

How are posterior urethral injuries managed

A
  • Suprapubic catheter and delayed urethroplasty
91
Q

What is a complication of urethral injury

A

Urethral stricture

Urology (14 decks)

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