230 - GU trauma

Question 1

What is the best test to assess a bladder injury?

Answer 1

Cystogram

Helps distinguish between intra and extraperitoneal bladder injury

Repair intraperitoneal, catheterize and observe if extraperitoneal

Question 2

What is the best first diagnostic test if a patient presents with blood at the urethral meatus?

Answer 2

Retrograde urethrogram (RUG)

DO NOT PLACE A FOLEY

Question 3

When should retrograde urethography (RUG) be performed?

Answer 3

If there is blood at the urethral meatus

Do this before attempting catheterization following urethral trauma

Question 4

What is the best imaging method to evaluate the testis?

Answer 4

Ultrasound

Question 5

What is the possible complication following penetrating penile trauma?

Answer 5

Stricture development

Question 6

What is the appropriate management of anterior urethral injury following blunt trauma?

What about posterior urethral injury??

Answer 6

• Anterior
  
  • Immediate repair
• Posterior
  
  • Place a suprapubic catheter
  • Delay repair

Surgical exploration + repair indiciated following any penetrating trauma

Question 7

What is the appropriate managment of intraperitoneal bladder injury?

What about extraperitoneal?

Answer 7

Intraperitoneal -> repair!

Extraperitoneal -> Catheter drainage, let it heal
Unless:
Surgery if injury to bladder neck, vaginal, rectum, bone fragments, or large defect

Use cystogram to differentiate between the two

Question 8

After suspected renal trauma, is further imaging warranted in this case?

Microscopic hematuria in a 6 year old, hemodynamically stable pt following a bicycle accident

Answer 8

Yes

Imaging with any hematuria in pediatric patients

Question 9

What is the most common cause of ureteral injury?

Answer 9

Penetrating injury (80-90% due to gunshot wound)

Blunt injury due to MVA

Ureteral injury is generally rare, and if it happens there are usually other life-threatinging things to deal with first

Question 10

What is the appropriate management if penile fracture is suspected?

Answer 10

Surgical exploration (promptly!)

US or MRI only needed if dignosis is unclear after history and physical

Question 11

What is the most significant risk factor for posterior urethral injury?

Answer 11

Pelvic fracture

Fractured pubic bone and anchored prostate tear away from membranous urethra

Question 12

What is the best imaging method for evaluating suspected ureteral injurY?

Answer 12

CT with IV contrast

Note: These pts will usually have other life-threatening injuries bc ureteral trauma is usually caused by severe deceleration injury or penetrating injury (ex: gunshot wound)

Question 13

What is the appropriate management of suspected testis rupture?

Answer 13

Surgical exploration and repair

Imaging only if diagnosis unclear after history and physical

Question 14

What are the aboslute indicateions for renal exploration following trauma?

Answer 14

Note: Renal exploration saves the person, not the kidney

• Life threatening bleeding
• UPJ Rupture
• Renal pedicle avulsion
• Expanding retroperitoneal hematoma

Thank you @Ben Gastevich!

Question 15

After suspected renal trauma, is further imaging warranted in this case?

Penetrating tauma, but no hematuria

Answer 15

Yes

Do imaging with ANY penetrating trauma

Question 16

After suspected renal trauma, is further imaging warranted in this case?

No gross or microscopic hematuria following a MVA in which the pts car crashed into a highway barrier

Answer 16

Yes

Do imaging following any deceleration injury

Question 17

After suspected renal trauma, is further imaging warranted in this case?

Microhematuria, hemodynamically stable afer blunt trauma

Answer 17

No