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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
Why is external ureteral injury rare
As ureters are mobile
26
How can internal ureteral injury present
- Ileus - Prolonged post-op fever - Persistent drainage from wounds
27
How does external ureteral injury present
- Flank pain - Peritonitis - Abdominal mass (Urinoma)
28
If external post-operative ureteral injury, how is it investigated
Intravenous urogram | Or, retrograde urogram
29
How is ureteric injury managed
- JJ Stent - Psoas hitch - Ureterostomy
30
What is a JJ Stent
Tube placed in ureter for 3-4W heal by primary intention
31
What is a psoas hitch
Bladder is attached to the psoas to lift it up in the pelvis - if urter shortened
32
What is a uterostomy
Damaged ureter is attached to the other ureter
33
How is an infected urinoma managed
IV Antibiotics Percutaneous Nephrostomy Delayed repair
34
What trauma can cause bladder trauma
- Blunt abdominal trauma (If Full) - Penetrating abdominal trauma - Pelvic fracture - Surgical procedures: TURBT, TURP, C-Section
35
What are the two types of bladder injury
1. Intraperitoneal = double fold of peritoneal membrane covering the bladder is damaged causing urine to leak into peritoneum 2. Extra-peritoneal = peritoneum is intact
36
What is the triad of symptoms in bladder injury
Suprapubic pain Inability to void Haematuria
37
What are two others features of bladder injury
Ileus (if intraperitoneal) | Abdominal distention - due to urine
38
How is bladder injury investigated
Retrograde cystography
39
Of the types of bladder injury, which is more severe
Intraperitoneal
40
How is intraperitoneal bladder injury managed
Surgically
41
How is extraperitoneal bladder injury managed
Conservatively - catheterise for 2W and then retrograde cystography to assess if healed
42
How are urethral injuries divided
Anterior and Posterior
43
What is the anterior urethra in males
Spongy urethra and Bulbar urethra
44
What is the anterior urethra in females
Distal 1/3
45
What is the posterior urethra in males
Prostatic and membranous urethra
46
What is the posterior urethra in females
Proximal 2/3
47
What urethral injuries is rare in females
As female urethra is short and poorly attached to the pelvis meaning it is rarely damaged in pelvic fractures
48
What is the main cause of anterior urethral injuries
Straddle injuries
49
What are 3 other causes of anterior urethral injuries
Penetrating Insertion Catheters - inflating balloon Penile surgery
50
What causes posterior urethral injuries
Pelvic Fractures
51
What are 2 other causes of posterior urethral injuries
TURP | Prolonged Injury
52
In which gender are posterior urethral injuries rare
Female
53
How do anterior urethral injuries present clinically
- Haematuria - Inability to void - Butterfly bruising
54
What causes butterfly bruising
Disruption of buck's fascia = enables blood to track into the scrotum
55
What is Buck's fascia
Deep layer of superficial fascia covering the penis
56
How do posterior urethral injuries present clinically
Haematuria Inability to void Per-anal bruising High-riding prostate
57
What causes a high riding prostate
Blood collects in retropubic space causing prostate to rise
58
How are urethral injuries investigated
Retrograde urethrogram
59
How are partial anterior urethral injuries managed
- Suprapubic catheter - Antibiotics - Retrograde urethrogram in 2W to assess healing
60
How are complete anterior urethral injuries managed
- Surgical repair
61
How are posterior urethral injuries managed
- Suprapubic catheter and delayed urethroplasty
62
What is a complication of urethral injury
Urethral stricture
63
What trauma can cause bladder trauma
- Blunt abdominal trauma (If Full) - Penetrating abdominal trauma - Pelvic fracture - Surgical procedures: TURBT, TURP, C-Section
64
What are the two types of bladder injury
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
What is the triad of symptoms in bladder injury
Suprapubic pain Inability to void Haematuria
66
What are two others features of bladder injury
Ileus (if intraperitoneal) | Abdominal distention - due to urine
67
How is bladder injury investigated
Retrograde cystography
68
Of the types of bladder injury, which is more severe
Intraperitoneal
69
How is intraperitoneal bladder injury managed
Surgically
70
How is extraperitoneal bladder injury managed
Conservatively - catheterise for 2W and then retrograde cystography to assess if healed
71
How are urethral injuries divided
Anterior and Posterior
72
What is the anterior urethra in males
Spongy urethra and Bulbar urethra
73
What is the anterior urethra in females
Distal 1/3
74
What is the posterior urethra in males
Prostatic and membranous urethra
75
What is the posterior urethra in females
Proximal 2/3
76
What urethral injuries is rare in females
As female urethra is short and poorly attached to the pelvis meaning it is rarely damaged in pelvic fractures
77
What is the main cause of anterior urethral injuries
Straddle injuries
78
What are 3 other causes of anterior urethral injuries
Penetrating Insertion Catheters - inflating balloon Penile surgery
79
What causes posterior urethral injuries
Pelvic Fractures
80
What are 2 other causes of posterior urethral injuries
TURP | Prolonged Injury
81
In which gender are posterior urethral injuries rare
Female
82
How do anterior urethral injuries present clinically
- Haematuria - Inability to void - Butterfly bruising
83
What causes butterfly bruising
Disruption of buck's fascia = enables blood to track into the scrotum
84
What is Buck's fascia
Deep layer of superficial fascia covering the penis
85
How do posterior urethral injuries present clinically
Haematuria Inability to void Per-anal bruising High-riding prostate
86
What causes a high riding prostate
Blood collects in retropubic space causing prostate to rise
87
How are urethral injuries investigated
Retrograde urethrogram
88
How are partial anterior urethral injuries managed
- Suprapubic catheter - Antibiotics - Retrograde urethrogram in 2W to assess healing
89
How are complete anterior urethral injuries managed
- Surgical repair
90
How are posterior urethral injuries managed
- Suprapubic catheter and delayed urethroplasty
91
What is a complication of urethral injury
Urethral stricture

Urology (14 decks)

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