ACUTE UROLOGICAL CONDITIONS Flashcards
Renal trauma
What is investigation workup of each ?
urine ds
Serial hematocrit
Imaging
Managment goals ?
Place of interventional radiology ?
Intervention is
indicated by continued fluid and blood resuscitation, peri-renal haematoma size > 3.5 cm and
presence of intravascular contrast extravasation.
Ureteral injury
Etiology
Presentation
Workup
Managment
Depends on the nature, severity and location of injury.
● Immediate diagnosis of a ligation injury during an operation can be managed by de-ligation
and stent placement. Partial injuries can be repaired immediately with stent or urine diversion
(nephrostomy). Stenting provides canalisation and may decrease risk of stricture.
● Proximal & mid third injuries: < 2-3 cm require primary uretero-ureterostomy. When not
feasible, a uretero-calycostomy may be undertaken and in cases of extensive ureteral loss, a
transuretero-ureterostomy.
● Distal: ureteral re-implantation (uretero-neocystostomy) is done as primary trauma usually
jeopardises blood supply to distal ureter.
● Complete: longer ureteral injury can be replaced using a segment of intestines (e.g., ileal
interposition graft).
● Principles of ureteral injury repair: Debridement of necrotic tissue→ Spatulation of ureteral
ends→ Watertight mucosa-to-mucosa anastomosis with absorbable sutures→ Internal
stenting- External drain→ Isolation of injury with peritoneum or omentum.
Bladder injury 1,2,3
● Clinical signs
Diagnosis
Management
Definition
Risk factors
Pathophysiology
Presentation
Diagnostic investigations
Complications
Grading /risk stratification
Management principles
Outcome
Urethral trauma
Definition
Risk factors
Pathophysiology
Presentation
Diagnostic investigations
Complications
Grading /risk stratification
Management principles
Outcome
Fourniers gangrene
Definition
Risk factors
Pathophysiology
Presentation
Diagnostic investigations
Complications
Grading /risk stratification
Management principles
Outcome
