EM Trauma 15: Genitourinary Flashcards
remarks on prostate
if the prostate is “missing” or riding high or feels boggy, assume disruption of the membranous urethra until proven otherwise
gold standard for the stable patient with suspected renal injury
IV contrast-enhanced CT scan of the abdomen and pevlis
remarks on grading of renal injury
grading correlates with the need for operative repair and nephrectomy
grade I renal injury
hematuria with normal anatomic studies (contusion) or
subscapular, non-expanding hematoma;
no laceration
grade II renal injury
perirenal, nonexpanding hematoma
or <1 cm renal cortex laceration with no urinary extravasation
grade III renal injury
>1 cm renal cortex laceration
with no collecting system involvement or urinary extravasation
grade IV renal injry
laceration through cortex and medulla and into collecting system or segmental renal artery or vein injury with hematoma
grade V renal injury
shattered kidney or
vascular injury to renal pedicle
or avulsed kidney
remarks on urinary extravasation
urinary extravasation alone is not an indication for exploration because it resolves spontaneously in the majority of cases
extravasation from a renal pelvis or ureteral injury, however, DOES require repair
nonop vs nonop of renal injuries
I, II, III - non-op
IV, V - selected can be non-op
delayed renal bleeding is most commonly due to
an arteriovenous fistula
- that has developed after a deep parenchymal laceration
- occurs in up to 25% of cases of grade III or IV injuries that are managed conservatively
- delayed bleeding can occur up to a month after injury
most common treatment [to hypertension in renal injury?]
nephrectomy
most common cause of ureteral injuries
intraoperative, iatrogenic damage (80%)
20% - external trauma
most common cause of external trauma to the ureteral injuries
penetrating trauma
