A6- Urological Trauma Flashcards
1
Q
Renal trauma is most common in….
A
young males
2
Q
What are the common mechanisms of injury in renal trauma
A
- Blunt injuries: MVAs, falls, sporting injuries, and assault
- Penetrating injuries: stab and gunshot wounds
3
Q
effects of blunt injuries
A
- The kidney and/or hilar structures are directly crushed as a result
- Less commonly, sudden deceleration may result in an avulsion injury affecting the vascular structures of the hilum or the pelvoureteric junction (PUJ)
4
Q
effects of Penetrating injuries: stab and gunshot wounds
A
- Tend to be more severe and less predictable than blunt trauma.
- Prevalence is higher in urban settings
- High-velocity bullets - greatest parenchymal destruction/ multiple-organ injuries
5
Q
Special considerations for renal trauma
A
- Known hydronephrosis or renal abnormality
- Single kidney
6
Q
: Indications for Renal Imaging
A
- visible haematuria
- non-visible haematuria and one episode of hypotension
- a history of rapid deceleration injury and/or significant associated injuries
- penetrating trauma
- clinical signs suggesting renal trauma e.g. flank pain, abrasions, fractured ribs, abdominal distension and/or a mass and tenderness.
7
Q
CT in renal trauma - 3 phase
A
- arterial phase: assesses vascular injury and presence of active extravasation of contrast
- nephrogenic phase: optimally demonstrates parenchymal contusions and lacerations
- delayed phase (5 minutes): identifies collecting system/ureteric injury
8
Q
What is the Renal injury grading scale
A
9
Q
Principles of management renal trauma
A
The initial management – ATLS principles
- Polytrauma should be managed in major trauma centres
- Damage control – limiting: hypothermia, coagulopathy and acidosis
10
Q
Management of Blunt Trauma
A
- Haemodynamically stable patient conservative management is preferred treatment option
- Bed rest, serial Hb and renal function, regular observations and repeat imaging
- Primary conservative management is associated with lower rate of nephrectomy and no increase in immediate or long term morbidity
11
Q
Blunt trauma grades management
A
- Grade 1 - 3 non-operatively
- Grade 4 - conservative, but intervention is higher urinary extravasation stent and/or percutaneous drainage
- Grade 5 - haemodynamic instability and major associated injuries There is thus a higher rate of exploration and nephrectomy
12
Q
What are some Reasons for surgical management
A
- Persistent haemodynamic instability or grade 5 vascular injury
- May require nephrectomy or debridement and partial nephrectomy
- Selective embolisation may have a role
13
Q
Complications of renal trauma
A
- Early (< 1 month) : bleeding, infection, perinephric abscess, sepsis, urinary fistula, hypertension, urinary extravasation and urinoma.
- Delayed : include bleeding, hydronephrosis, calculus formation, chronic pyelonephritis, hypertension, arteriovenous fistulae (AVF), hydronephrosis and pseudo-aneurysms.
14
Q
Classifciation of bladder trauma?
A
- Intraperitoneal / Extraperitoneal / Combined
- Non iatrogenic / Iatrogenic
15
Q
Non iatrogenic mechanisms of injury
Extraperitoneal:
A
- associated with pelvic fractures
- shearing of the anterolateral bladder wall near the bladder base (at its fascial attachments), or by a contrecoup at the opposite side
- Rarely directly perforated by a sharp bony fragm
17
Q
Iatrogenic Injury
examples
A
- Intra-operative: visible laceration, visible bladder catheter, and blood and/or gas in the urine bag during laparoscopy
- During TURBT / TURP: cystoscopic identification of fatty tissue, dark space, or bowel, inability to distend the bladder, low return of irrigation fluid, or abdominal distension
- Post-operatively: missed bladder trauma is diagnosed by haematuria, abdominal pain, abdominal distension, ileus, peritonitis, sepsis, urine leakage from the wound, decreased urinary output, or increased serum creatinine
23
Q
Ureteric Trauma
Iatrogenic Injury causes
A
