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RGU 3 > Genitourinary Tract Trauma > Flashcards

Genitourinary Tract Trauma Flashcards

1
Q

What is the leading cause of death between the ages of 1 and 44?

A
  • trauma
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2
Q

When will the urologist most likely be the most important member of the team in trauma?

A
  • 2 weeks after trauma.
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3
Q

What is the most commonly injured organ in the urogenital system?

A
  • kidney

* occurs in 10% of all abdominal traumas.

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4
Q

Are most renal traumas from blunt or penetrating types?

A
  • blunt (80-90%)

* secondary to MVAs, contact sports, falls, and assaults.

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5
Q

What may you see with blunt traumas?

A
  • flank ecchymosis

- microscopic or gross hematuria

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6
Q

What is the window to the urinary tract?

A
  • urinalysis
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7
Q

What should we look for on dipstick of urine to observe for microscopic hematuria?

A
  • 5-10 RBCs/hpf
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8
Q

What trauma situations always require imaging?

A
  • all ADULTS with penetrating or blunt trauma associated with gross or microscopic hematuria with shock (less than 90 SBP).
  • all PEDIATRICS with any hematuria.
  • use CT for both.
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9
Q

What are the 5 grades of kidney trauma?

A
  • Grade I= contusion with intact capsule.
  • Grade II= superficial laceration with blood outside the capsule of the kidney.
  • Grade III= deeper laceration through the corticomedullary junction.
  • Grade IV= injury into the collecting system where the urine drains or into one of the segmental vessels of the kidney or renal artery thrombosis.
  • Grade V= multiple deep lacerations
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10
Q

** What is pathognomonic for renal artery thrombosis (GRADE IV injury) on imaging?

A

cortical rim sign

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11
Q

How do we manage most renal injuries?

A
  • non-operatively for grades 1-4. Bed rest, serial hematocrit, and follow-up imaging.
  • only 7% require operative intervention.
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12
Q

What are the indications for exploratory laparotomy (surgery)?

A
  • expanding or pulsatile hematoma (absolute indication).
  • extravasation
  • non-viable tissue
  • arterial injury
  • incomplete staging
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13
Q

What should you do for a retroperitoneal hematoma?

A
  • check to see if both kidneys are present using single-shot IVP.
  • renal exploration if abnormal or equivocal.
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14
Q

How do we do an exploratory kidney surgery in the OR?

A
  • incision from xiphoid to pubic bone
  • pull bowels out of retroperitoneum and make an incision in the mesentery at the aorta where the renal arteries are found. This way we can have vascular control.
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15
Q

What are the reconstructive principles for kidney surgery in trauma?

A
  • total renal exposure
  • debridement
  • hemostasis
  • water-tight closure
  • defect coverage
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16
Q

*** What are the important points to remember about renal trauma?

A
  • diagnosis
  • staging
  • active and attentive observation
  • selective surgery
  • renal reconstruction and salvage.
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17
Q

With what are 85% of traumatic bladder ruptures associated?

A
  • pelvic fractures
18
Q

What is the most important laboratory test for bladder trauma?

A
  • urinalysis

* almost all bladder injuries have hematuria (mostly gross).

19
Q

What is the definitive study for diagnosing bladder trauma?

A
  • cystography by injecting the bladder with contrast.
20
Q

How do we classify bladder trauma?

A
  • minor= contusions

- major= intraperitoneal or extraperitoneal

21
Q

What must you do with CT cystography?

A
  • provacatively fill bladder with 300-400 cc of water soluble contrast.
  • cannot rely on passive bladder filling.
22
Q

Are most bladder ruptures inside or outside of the peritoneal cavity?

A
  • outside (extraperitoneal)

* just place foley catheter and let it heal on its own. Repeat cystogram prior to removal of catheter.

23
Q

Do all penetrating injuries to the bladder require operative repair?

A

YES

24
Q

What are the types of urethral injuries?

A
  • anterior= PENETRATING and STRADDLE injuries
  • posterior= DISTRACTION injuries
  • landmark for division is the external urethral sphincter.
25
Q

What will you see with urethral injuries?

A
  • blood at the meatus in 75% of anterior injuries.
  • hematuria
  • inability to void
  • high riding prostate
  • inability to pass catheter.
26
Q

What is a STRADDLE injury (anterior urethral injury)?

A
  • pinching the urethra between something like a bike bar causing disruption to one side of the bulbar urethra.
27
Q

What limits straddle injuries?

A
  • colles fascia, which can allow for blood to traverse as high as the clavicles in a big trauma, because it is in continuity with scarpa’s fascia in the abdominal wall.
28
Q

How do we manage straddle injuries?

A
  • divert urine with suprapubic tube right through abdominal wall.
  • fix orthopaedic injuries after everything has calmed down.
29
Q

What is a DISTRACTION (posterior urethral) injury?

A
  • separation of posterior urethra (bc it can act as a fulcrum in any sheering trauma) with accumulation of blood causing further distraction of anterior and posterior urethra.
30
Q

Should you ever pass a foley catheter with blood at the urethral meatus?

A

NO

*obtain a retrograde urethrogram (squirt dye into the penis)

31
Q

How do you repair a posterior disrupted urethra?

A
  • make incision in the perineum, removed injured portion and reconnect.
32
Q

What are the important points about urethral injuries?

A
  • confirm diagnosis with URETHROGRAM.
  • assess overall status of patient and allow this to dictate intervention.
  • meticulous technique to repair properly.
33
Q

How do we confirm diagnosis of scrotal injuries?

A
  • ultrasound
34
Q

What should we do for testicular rupture?

A
  • OR management within 72 hours of injury.
  • midline scrotal incision
  • expose and debride exposed tubules.
  • testicular salvage for improved self image and maintenance of hormonal function.
35
Q

How do we manage scrotal hematomas or testicular contusions?

A
  • non-operatively
36
Q

How do we manage all penetrating injuries and to the scrotum?

A
  • OR exploration
37
Q

What is a penile fracture?

A
  • trauma to an erect penis causing audible “pop”, detumescence (erection goes down), hematoma, and swelling.
  • potential for urethral injury 20% of the time.
38
Q

How do you manage a penile fracture?

A
  • surgically: expose via a circumcision incision to allow for access to both corpora and the urethra. Debride hematoma and repair.
39
Q

How do penile amputations occur?

A
  • self-inflicted or an act of violence.

- preserve in cold saline and then reattach.

40
Q

How does genital skin loss occur?

A
  • traumatic shear injury (chemical burn…) or as a sequelae of infection.
41
Q

How do you manage genital skin loss?

A
  • debride dead tissue.
  • antibiotics
  • tuck testicles into the thigh to keep them warm.
  • take testicles back out and then skin graft where needed.

RGU 3 (19 decks)

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