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17th European Urology Residents Education Programme > Trauma > Flashcards

Trauma Flashcards

1
Q

What is the incidence of urinary tract trauma?

A

10%

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2
Q

How common is renal trauma?

A

1-5% of all trauma

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3
Q

What is the male to female ratio when it comes to urogenital trauma?

A

3:1

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4
Q

How effective are airbags when it comes to renal trauma?

A

decreases renal injuries by 40-50%

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5
Q

How common is renal vasculary injury in renal trauma?

A

<5%

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6
Q

What are the indication for imaging in renal trauma?

A

Blunt trauma:
gross hematuria
microhematuria + hypotension
rapid desceleration injuries

Penetrating trauma:
all with hematuria
clinical suspicion (inlet or exit wound)

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7
Q

What laboratory tests should be performed on a patient who has suffered renal trauma?

A

Urine
Hematocrit
Creatinine (8 hrs before change can be measured)

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8
Q

When should on shot intraoperative IVP be used?

A

In those, unstable, subjected to laparotomy
to see the condition of the contralateral kidney

2 ml/kg contrast, single x-ray after 10 min

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9
Q

What is importernt to remember when performing a CT on a patient with a suspected urinary tract injury?

A

2 phase study

both a vascular phase and a
delayed phase afte 10 min to look for peri-renal or ureteral contrast extravasation

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10
Q

When should you use an MRI to evaluate a patient with suspected urinary tract injury?

A

CT is not availabel
Iodine allergy
CT findings are equivocal

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11
Q

When is angiography indicated for a patient with suspected urinary tract injury?

A

stable patient when therapeutic angio-embolization is needed
or
non enhanced cortex on CT-scan (suspection of total avulsion, renal artery thrombosis or severe concussion causing vascular spasm)

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12
Q

Renal score AAST Grade 1:

A

contusion or subcapsular hematoma

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13
Q

Renal score AAST Grade 2:

A

Cortical laceration <1 cm no extra-vasation

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14
Q

Renal score AAST Grade 3:

A

Cortical laceration >1 cm no extra-vasation

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15
Q

Renal score AAST Grade 4:

A

Laceration > 1cm with injury to the collecting system
and/or
Thrombosed artery or segmental vein injury

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16
Q

Renal score AAST Grade 5:

A

Shattered kidney
and/or
Renal pedicle avulsion

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17
Q

Indication for renal exploration:

A

continues hemodyamic instability (in spite of resuscitation)
expanding retroperitoneal hematoma
pre-existing abnormality (hydronephrosis, tumour)

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18
Q

What is the treatment when PNL has caused trauma to the colon?

A 
Liberal drainage of the PCS
Keep the tube in the perinephric and pericolic spaces 
Antibiotics
Stop oral feedings for 5 days
Success rate is very high
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19
Q

What is the most common cause of ureteral trauma?

A

Iatrogenic 75%
blunt 18%
penetrating 7%

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20
Q

What type of iatrogenic trauma is most common?

A

Gynecologic 70%
General surgery 14%
Urology 16%

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21
Q

Ureteral trauma AAST Grade 1:

A

hematoma and/or contusion

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22
Q

Ureteral trauma AAST Grade 2:

A

laceration < 50% of circumference

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23
Q

Ureteral trauma AAST Grade 3:

A

laceration > 50% of circumference

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24
Q

Ureteral trauma AAST Grade 4:

A

complete tear < 2 cm loss

25
Q

Ureteral trauma AAST Grade 5:

A

complete tear ≥ 2 cm loss

26
Q

How often is an injury to the ureter overlooked?

A

60%

27
Q

What can be symptoms that leads to a late diagnosis of ureteral injury?

A 
Leakage
Acute obstruction
Sepsis
Uro-ascites
Urinoma
Fistula
28
Q

When should surgical repair of a urethral injury be undertaken?

A

Within one week
or
after 2-3 months

29
Q

Examples of surgical techniques for re-continuity of urethers:

A

end to end anastomosis
Transuretero-ureterostomy
Uretero-calycostomy
Boari flap ± psoas hitch

Auto transplantation
Ileal segment interposition

30
Q

What is the most common cause of bladder trauma?

A

70-80% due to pelvic fracture

31
Q

Symptoms of bladder injury:

+ symptoms of silent rupture

A

Hematuria
Pain
No desire or inability to void
Urine leak and/or blood through the vagina

in silent rupture:
ileus
ascites
peritonitis
uremia 
sepsis
toxemia
32
Q

Bladder trauma AAST Grade 1:

A

concussion, intramural hematoma partial thickness

33
Q

Bladder trauma AAST Grade 2:

A

extra peritoneal rupture < 2 cm

34
Q

Bladder trauma AAST Grade 3:

A

extra peritoneal rupture > 2 cm or intra peritoneal rupture < 2 cm

35
Q

Bladder trauma AAST Grade 4:

A

Intraperitoneal rupture ≥ 2 cm

36
Q

Bladder trauma AAST Grade 5:

A

extra or intra peritoneal laceration extending into the bladder neck or trigone

37
Q

Radiological diagnosis of bladder trauma:

A

Retrograde gravity cystography (also excludes urethral trauma)

CT can be used especially if other trauma is present

38
Q

When is surgical repair indicated in bladder trauma?

A

Intraperitoneal rupture or extraperitoneal rupture when drainage is not guaranteed or surgery is indicated for other injuries

39
Q

Postoperative care after surgical treatment of bladder injury:

A

Antibiotics
Catheter 10 days
Retrograde cystogram before catheter removal
(if leakage, catheter for another 5 days)

40
Q

Penile trauma AAST Grade 1:

A

Cutaneous laceration or contusion

41
Q

Penile trauma AAST Grade 2:

A

Laceration of Buck’s fascia (cavernosum) withour tissue loss

42
Q

Penile trauma AAST Grade 3:

A

Cutaneous avulsion, laceration through glans or meatus

or cavernosal or urethral defect < 2cm

43
Q

Penile trauma AAST Grade 4:

A

partial penectomy

or cavernosal or urethral defect ≥ 2 cm

44
Q

Penile trauma AAST Grade 5:

A

total penectomy

45
Q

What is the most common cause of posterior urethral trauma?

A

pelvic fracture

present i 4-14 % of pelvic fracture cases
males>females

46
Q

How often is posterior urethral injury associated with bladder rupture?

A

10-17%

47
Q

How common is urethro-rectal fistula after posterior urethral injury?

A

up to 8%

48
Q

What clinical signs should arise suspicion of posterior urethral injury?

A

Blood at the meatus
Inability to urinate
Full bladder

49
Q

Urethral injury AAST Grade 1:

A

Contusion: blood at the meatus

50
Q

Urethral injury AAST Grade 2:

A

Stretch injury: elongation of the urethra without extravasation

51
Q

Urethral injury AAST Grade 3:

A

Partial disruption: extravasation at injury site with bladder visualization

52
Q

Urethral injury AAST Grade 4:

A

Complete disruption: Extravasation at the injury site without bladder visualization < 2 cm urethral separation

53
Q

Urethral injury AAST Grade 5:

A

Complete disruption: Complete transection with ≥ 2 cm separation or extension to the prostate of vagina

54
Q

How do you confirm an urethral injury?

A

Urethrography

55
Q

What options are there when it comes to the timing of surgical treatment for an urethral injury?

A

Immediate: < 48H
Delayed: 2 days- 2 weeks
Deferred: > 3 months

56
Q

How should a complete posterior urethral rupture be treated?

A

Immediate realignment (with catheter for 4-8 weeks)

then Deferred urethroplasty

sucessrate 80-98%

57
Q

What are the most common complications from posterior urethral injuries?

A

Impotence

Incontinence

58
Q

How should you treat Anterior Urethral Trauma?

A

Open repair over catheter alignment

or suprapubic tube without repair

59
Q

What kind of trauma can cause Anterior Urethral injury?

A

Straddel injury
Sexual intercourse
Gunshots
Iatrogenic trauma

17th European Urology Residents Education Programme (17 decks)

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