Emergency- Urological trauma Flashcards
How would assess a patient with a suspected renal trauma?
Immediate assessment due to renal trauma. Multidisciplinary approach with the A&E, ensure C-spine and pelvic stabilisation and assessment using ABCDE approach according to ATLS approach
Provide O2, fluids, bloods- FBC, Coag, U&Es, CRP, G&S
top to toe examination but from Urology would assess abdo- scars, peritonitis, flank tenderness and bruising, and trauma to external gen, VH. perineal bruising, and DRE to assess a high riding prostate to rule out bladder and urethral injury
What are the classification of renal trauma?
The AAST [American Association of Surgical trauma] splits renal trauma into 5 classes
Class 1= renal contusion
Class 2= laceration <1cm, non expanding haematoma
Class 3= laceration >1cm
Class 4= laceration into the renal pelvis causing urinary extravasation, segmental vessel disruption
Class 5= completely shattered kidney, complete disruption of the renal pelvis or pedicle devascularisation
What form of imaging would you perform for a query bladder rupture?
ct cystogram
What are the treatment options of renal trauma?
Class 1-3= mainly admit and conservation
Class 4-5= urgent angiography +/- embolization, or surgery and renal exploration
Indication for surgery:
- Haemodynamic instability
- penetrating renal trauma
- renal pedicle avulsion
What form of imaging would you perform for a potential ureteric injury?
CT IVU
What are the management options for a ureteric injury?
Class 1= surrounding haematoma, conservative +/- stenting
Class 2= <50% circumference lacerated, stent +/- suture
Class 3= >50% circumference lacerated, stent +/- suture, ureterouterostomy + stent
Class 4= complete tear <2cm devascularisation, recon
Class 5= complete tear >2cm devascularisation, recon
If patient unstable or not suitable for open surgery then consider nephrostomies and deal with injury when stable.
What findings would suggest a bladder injury?
suprapubic pain, history of trauma/TURBT, VH and inability to void
What imaging would you perform for a possible bladder injury?
Stressed CT urogram.
Catheterise patient and inject at least 300ml of 50/50 diluted contrast to distend bladder.
How would you manage a bladder rupture?
Extraperitoneal= catheterise and conservative. Catheter for 2 weeks and perform repeat stress cystogram to confirm repair
Intraperitoneal= require surgical repair with a double layer closure technique
What findings would you find that would raise the suspicion of a urethral injury?
Distended bladder, Visible haematuria, perineal bruising, boggy and high riding prostate
What imaging would you perform for a urethral injury?
retrograde urethrogram
or a voiding cystourethrogram
How would you managed a patient with a potential urethral injury?
GENTLY attempt to catheterise the patient with a urethral catheter, but any resistance would mean SPC insertion under USS guidance. If bladder cannot be identified- open cystotomy
