SM_230b: Genitourinary Trauma Flashcards

1
Q

Degree of hemature ___ correlate with degree of injury in penetrating trauma

A

Degree of hemature does NOT correlate with degree of injury in penetrating trauma

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2
Q

Describe indications for radiologic assessment of genitourinary trauma

A

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
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3
Q

Describe absolute indications for renal exploration following trauma

A

Absolute indications for renal exploration following trauma

  • Life threatening bleeding
  • UPJ rupture
  • Renal pedicle avulsion
  • Expanding retroperitoneal hematoma
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4
Q

Describe fascias in the retroperitoneum

A

Fascias in the retroperitoneum

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5
Q

Angioembolization is used for ___

A

Angioembolization is used for major injuries (renal ruptures / shattered kidneys / pedicle avulsions)

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6
Q

Describe key points of renal trauma

A

Renal trauma

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7
Q

Cystogram allows differentiation of ____

A

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
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8
Q

Describe management of bladder injury

A

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
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9
Q

Retrograde urethrography should be performed in patients with ___

A

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)
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10
Q

Anterior urethra has ____, ____, and ____ sections

A

Anterior urethra has fossa navicularis, penile, and bulbar sections

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11
Q

Posterior urethra has ____ and ____ sections

A

Posterior urethra has prostatic and membranous sections

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12
Q

Posterior urethra can be injured in pelvic fracture related urethral injury because ___

A

Posterior urethra can be injured in pelvic fracture related urethral injury because fractured pubic bone and anchored prostate tear away from membranous urethra

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13
Q

Do not place a Foley catheter unless ___ has been ruled out

A

Do not place a Foley catheter unless urethral injury has been ruled out

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14
Q

Trauma to anterior urethra is treated with ___

A

Trauma to anterior urethra is treated with immediate repair

(urethral catheter drainage if blunt trauma)

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15
Q

Trauma to posterior urethra is treated with ____

A

Trauma to posterior urethra is treated with suprapubic diversion and delayed repair

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16
Q

Penile fracture occurs when ____, ____, or ____

A

Penile fracture occurs when tunica albuginea thins out during erection, blunt trauma shears tunica, or there is a sudden increase in intracavernosal pressure

17
Q

Penile fracture presents as ____, ____, ____, ____, and ____

A

Penile fracture presents as popping sound, acute penile pain and swelling, eggplant deformity, rapid detumesence, and ± hematuria

18
Q

Tunica albuginea ____ in diameter during erection which causes an ____ in pressure

A

Tunica albuginea decreases in diameter during erection which causes an increase in pressure

19
Q

Penile fracture occurs due to ___, ___, or ___

A

Penile fracture occurs due to coitus, masturbation, or freak accidents

20
Q

Penile fracture is treated with ____

A

Penile fracture is treated with penile exploration

21
Q

Blunt trauma to penis should make you suspect ____

A

Blunt trauma to penis should make you suspect penile fracture

22
Q

Penetrating penile trauma is treated with ____ or ____

A

Penetrating penile trauma is treated with surgical exploration (deglove, irrigate, debride) or conservative management (only if superficial or tangential)

23
Q

Penile amputation involves ____

A

Penile amputation involves replantation with microvascular reanastamosis

24
Q

Evaluate the urethra after penile injury if ____, ____, or ____

A

Evaluate the urethra after penile injury if hematuria, unable to void, or blood at meatus

25
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
26
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
27
\_\_\_\_ is ultrasound finding indicating testicular rupture
Heterogeneous echo pattern within testicular parenchyma with loss of contour is ultrasound finding indicating testicular rupture
28
\_\_\_\_ is optimal for blunt scrotal trauma
Timely surgical exploration is optimal for blunt scrotal trauma * Highest salvage rate * Hematocele is \> 5 cm in size
29
Ureteral trauma management involves ___ and \_\_\_
Ureteral trauma management involves IR drainage of fluid collection and urinary drainage via ureteral stent or percutaneous nephrostomy
30
\_\_\_ or ___ can damage the ureter
Avulsion of the ureter or rapid deceleration injury can damage the ureter
31
\_\_\_\_ is the imaging modality to assess suspected ureteral injury
IV contrast CT is the imaging modality to assess suspected ureteral injury
32
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
33
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