Genitourinary Trauma Flashcards
imaging “gold standard” for the stable patient with suspected renal injury
IV contrast-enhanced CT scan of the abdomen and pelvis
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
True
What imaging to use?
Multisystem trauma or suspected renal parenchymal or vascular injury
Abdominal pelvic IV contrast CT Scan
What imaging to use?
Any visceral injury resulting in free intraperitoneal fluid
FAST
What imaging to use?
Renal artery injury
Renal angiography
What imaging to use?
Ureteral injury
Abdominal-pelvic IV contrast CT scan
What imaging to use?
Bladder injury
Retrograde cystogram
What imaging to use?
Urethral injury
Retrograde urethrogram
What imaging to use?
Scrotal/testicular injury
Color Doppler US
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
True
In Urethral injury, Retrograde urethrogram if performed prior to abdominal- pelvic contrast CT scan, can interfere with diagnosis
True
True or false
Scrotal/testicular injury
Contrast-enhanced US or MRI if suspicion is high and initial US is negative
True
Renal Injury Scale
Hematuria with normal anatomic studies (contusion) or subcapsular, non-expanding hematoma; no laceration
Grade I
Renal Injury Scale
Perirenal, nonexpanding hematoma or <1 cm renal cortex laceration with no urinary extravasation
Grade II
Renal Injury Scale
> 1 cm renal cortex laceration with no collecting system involvement or urinary extravasation
Grade III
Renal Injury Scale
Laceration through cortex and medulla and into collecting system or segmental renal artery or vein injury with hematoma
Grade IV
Renal Injury Scale
Shattered kidney or vascular injury to renal pedicle or avulsed kidney
Grade V
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
True
Disposition:
Grade I injury:
Those with a renal contusion (microscopic hematuria with normal imaging)
Discharge
Disposition:
subcapsular hematoma
admitted for a short observation stay followed by a hematocrit and clinical reevaluation
Disposition:
gross hematuria
need admission and require bed rest until the gross hematuria clears
Disposition:
grade II or higher injury
Admit to trauma surgeon, general surgeon, or urologist
Interpret
Normal retrograde urethrogram
Interpret
Extravasation of contrast in retrograde urethrogram
Posterior urethral injury is suggested by the triad of
urinary RETENTION
BLOOD at the meatus
HIGH-RIDING prostate
How to perform retrograde urethrogram
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.
Identify
Eggplant deformity
Penile fracture mechanism of injury
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”)
Zipper injury to the penis is caused when the penile skin is trapped in the trouser zipper.
What is management?
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.
