SM_230b: Genitourinary Trauma Flashcards
Degree of hemature ___ correlate with degree of injury in penetrating trauma
Degree of hemature does NOT correlate with degree of injury in penetrating trauma
Describe indications for radiologic assessment of genitourinary trauma
Indications for radiologic assessment of genitourinary trauma
- Flank / abdominal penetrating trauma
- Blunt trauma with gross hematuria
- Blunt trauma with microhematuria and shock
- Deceleration injuries
- Pediatric injuries with any hematuria
Describe absolute indications for renal exploration following trauma
Absolute indications for renal exploration following trauma
- Life threatening bleeding
- UPJ rupture
- Renal pedicle avulsion
- Expanding retroperitoneal hematoma
Describe fascias in the retroperitoneum
Fascias in the retroperitoneum
Angioembolization is used for ___
Angioembolization is used for major injuries (renal ruptures / shattered kidneys / pedicle avulsions)
Describe key points of renal trauma
Renal trauma
Cystogram allows differentiation of ____
Cystogram allows differentiation of extra vs intraperitoneal injury
- Gravity cystogram: contrast, pre and post drainage films, fluoroscopy
- Gross hematuria in hemodynamically stable patient following pelvic trauma requires a retrograde cystogram
Describe management of bladder injury
Management of bladder injury
- Uncomplicated extraperitoneal injury: urethral catheter drainage alone
- Complicated extraperitoneal injury (bladder neck injury, bone spicule in bladder, rectal injury, vaginal injury): surgical repair
- Intraperitoneal injury (trauma or iatrogenic): surgical repair
Retrograde urethrography should be performed in patients with ___
Retrograde urethrography should be performed in patients with blood at the urethral meatus after pelvic trauma
- Retrograde injection of contrast under fluoroscopy
- Diagnosis of urethral injury
- Diagnosis of location of urethral pathology (anterior vs posterior)
Anterior urethra has ____, ____, and ____ sections
Anterior urethra has fossa navicularis, penile, and bulbar sections
Posterior urethra has ____ and ____ sections
Posterior urethra has prostatic and membranous sections
Posterior urethra can be injured in pelvic fracture related urethral injury because ___
Posterior urethra can be injured in pelvic fracture related urethral injury because fractured pubic bone and anchored prostate tear away from membranous urethra
Do not place a Foley catheter unless ___ has been ruled out
Do not place a Foley catheter unless urethral injury has been ruled out
Trauma to anterior urethra is treated with ___
Trauma to anterior urethra is treated with immediate repair
(urethral catheter drainage if blunt trauma)
Trauma to posterior urethra is treated with ____
Trauma to posterior urethra is treated with suprapubic diversion and delayed repair
Penile fracture occurs when ____, ____, or ____
Penile fracture occurs when tunica albuginea thins out during erection, blunt trauma shears tunica, or there is a sudden increase in intracavernosal pressure
Penile fracture presents as ____, ____, ____, ____, and ____
Penile fracture presents as popping sound, acute penile pain and swelling, eggplant deformity, rapid detumesence, and ± hematuria
Tunica albuginea ____ in diameter during erection which causes an ____ in pressure
Tunica albuginea decreases in diameter during erection which causes an increase in pressure
Penile fracture occurs due to ___, ___, or ___
Penile fracture occurs due to coitus, masturbation, or freak accidents
Penile fracture is treated with ____
Penile fracture is treated with penile exploration
Blunt trauma to penis should make you suspect ____
Blunt trauma to penis should make you suspect penile fracture
Penetrating penile trauma is treated with ____ or ____
Penetrating penile trauma is treated with surgical exploration (deglove, irrigate, debride) or conservative management (only if superficial or tangential)
Penile amputation involves ____
Penile amputation involves replantation with microvascular reanastamosis
Evaluate the urethra after penile injury if ____, ____, or ____
Evaluate the urethra after penile injury if hematuria, unable to void, or blood at meatus
Describe differential diagnosis for scrotum injury
Differential diagnosis for scrotum injury
- Trauma: testis rupture, hematocele
- Torsion: testicle, appendix testis, and epididymis
- Epididymo-orchitis
- Hernia
- Hydrocele, spermatocele, varicocele
- Tumor
Blunt scrotal trauma presents as ____ and involves ____, ____, and ____ on physical exam
Blunt scrotal trauma presents as significant pain and involves firm scrotum, tender scrotum, and ecchymosis on physical exam
- Testis entrapped against bony structure
- 50 kg force to cause rupture
____ is ultrasound finding indicating testicular rupture
Heterogeneous echo pattern within testicular parenchyma with loss of contour is ultrasound finding indicating testicular rupture
____ is optimal for blunt scrotal trauma
Timely surgical exploration is optimal for blunt scrotal trauma
- Highest salvage rate
- Hematocele is > 5 cm in size
Ureteral trauma management involves ___ and ___
Ureteral trauma management involves IR drainage of fluid collection and urinary drainage via ureteral stent or percutaneous nephrostomy
___ or ___ can damage the ureter
Avulsion of the ureter or rapid deceleration injury can damage the ureter
____ is the imaging modality to assess suspected ureteral injury
IV contrast CT is the imaging modality to assess suspected ureteral injury
Ureteral injury is usually associated with ____ so manage with ____ and ____
Ureteral injury is usually associated with other life-threatening injuries so manage with urinary drainage and delayed repair
Endoscopic ureteral injuries (iatrogenic) should be managed with ____ and / or ____
Endoscopic ureteral injuries (iatrogenic) should be managed with ureteral stent and / or percutaneous nephrostomy tube
