Genitourinary Trauma

Question 1

imaging “gold standard” for the stable patient with suspected renal injury

Answer 1

IV contrast-enhanced CT scan of the abdomen and pelvis

Question 2

True or false

The FAST examination is useful for identifying free intraperitoneal fluid, but does not specifically evaluate renal injury and does not identify renal vascular injury

Answer 2

True

Question 3

What imaging to use?

Multisystem trauma or suspected renal parenchymal or vascular injury

Answer 3

Abdominal pelvic IV contrast CT Scan

Question 4

What imaging to use?

Any visceral injury resulting in free intraperitoneal fluid

Answer 4

FAST

Question 5

What imaging to use?

Renal artery injury

Answer 5

Renal angiography

Question 6

What imaging to use?

Ureteral injury

Answer 6

Abdominal-pelvic IV contrast CT scan

Question 7

What imaging to use?

Bladder injury

Answer 7

Retrograde cystogram

Question 8

What imaging to use?

Urethral injury

Answer 8

Retrograde urethrogram

Question 9

What imaging to use?

Scrotal/testicular injury

Answer 9

Color Doppler US

Question 10

True or false

In Ureteral injury, delayed films are needed to identify extravasation

Obtain IV pyelogram or retrograde pyelogram if still suspicious with negative CT

Answer 10

True

Question 11

In Urethral injury, Retrograde urethrogram if performed prior to abdominal- pelvic contrast CT scan, can interfere with diagnosis

Answer 11

True

Question 12

True or false

Scrotal/testicular injury

Contrast-enhanced US or MRI if suspicion is high and initial US is negative

Answer 12

True

Question 13

Renal Injury Scale

Hematuria with normal anatomic studies (contusion) or subcapsular, non-expanding hematoma; no laceration

Answer 13

Grade I

Question 14

Renal Injury Scale

Perirenal, nonexpanding hematoma or <1 cm renal cortex laceration with no urinary extravasation

Answer 14

Grade II

Question 15

Renal Injury Scale

> 1 cm renal cortex laceration with no collecting system involvement or urinary extravasation

Answer 15

Grade III

Question 16

Renal Injury Scale

Laceration through cortex and medulla and into collecting system or segmental renal artery or vein injury with hematoma

Answer 16

Grade IV

Question 17

Renal Injury Scale

Shattered kidney or vascular injury to renal pedicle or avulsed kidney

Answer 17

Grade V

Question 18

True or false

Delayed bleeding can occur up to a month after injury and is most commonly due to an arteriovenous fistula that has developed after a deep parenchymal laceration

Answer 18

True

Question 19

Disposition:
Grade I injury:
Those with a renal contusion (microscopic hematuria with normal imaging)

Answer 19

Discharge

Question 20

Disposition:

subcapsular hematoma

Answer 20

admitted for a short observation stay followed by a hematocrit and clinical reevaluation

Question 21

Disposition:

gross hematuria

Answer 21

need admission and require bed rest until the gross hematuria clears

Question 22

Disposition:

grade II or higher injury

Answer 22

Admit to trauma surgeon, general surgeon, or urologist

Question 23

Interpret

Answer 23

Normal retrograde urethrogram

Question 24

Interpret

Answer 24

Extravasation of contrast in retrograde urethrogram

Question 25

Posterior urethral injury is suggested by the triad of

Answer 25

urinary RETENTION BLOOD at the meatus HIGH-RIDING prostate

Question 26

How to perform retrograde urethrogram

Answer 26

Gently injecting 20 to 30 mL of contrast into the urethra and obtaining a radiograph Extravasation identifies the existence and location of the urethral tear In partial anterior urethral lacerations : contrast extravasation at the site of injury and contrast material outlining the urethra proximal to the site of injury In complete anterior urethral lacerations : contrast extravasation at the site of injury WITHOUT contrast proximal to the site of injury. Extravasation of contrast along fascial planes of the perineum is another indication of urethral disruption.

Question 27

Identify

Answer 27

Eggplant deformity

Question 28

Penile fracture mechanism of injury

Answer 28

Penile fracture, with or without urethral injury, occurs when the corpus cavernosum ruptures after being forcibly bent, usually during sexual intercourse. A cracking sound may be heard, followed by penile pain, rapid swelling, discoloration, and visible deformity (“eggplant deformity”)

Question 29

Zipper injury to the penis is caused when the penile skin is trapped in the trouser zipper. What is management?

Answer 29

MINERAL OIL and LIDOCAINE infiltration are useful in freeing the penile skin from the zipper. Otherwise, wire-cutting or bone-cutting pliers are used to divide the median bar (or diamond) of the zipper.