Urogenital Trauma Flashcards
The____ are the most commonly injured UG organ
kidneys
What are some of the underlying pathological injuries to the kidneys
Hydronephrosis and Tumours
What are the 5 factors that protect kidneys
- Ribcage
- Posterior abdominal wall
- Anterior visceral wall
- Perinephric fat and fascia
- The fact that kidneys are retroperitoneal
Give 3 examples of blunt trauma to the kidneys
- MVA
- assault
- A fall
Give 3 examples of penetrating trauma to the kidneys
- Stab wounds
- GSW
- Iatrogenic-PCNL and renal biopsy
Define primary haemorrhage
This is bleeding that occurs at the onset of injury
Define secondary haemorrhage
This is bleeding that occurs after 10-14 days after the injury. Associated with haematoma that clears up in the renal parenchyma and goes into the collecting ducts
Name 4 clinical presentations of renal injury
- Haematuria
- Flank, back and loin pain
- Laceration at the place of injury
- May have haemorrhagic shock
Urine extravasation definition:
A disruption of the urethra that leads to the collection of urine in other cavities such as the scrotum etc.
What is grade 1 kidney injury?
This is subcapsular hamaetoma and has no laceration or urinary extravasation
What is grade 2 kidney injury?
This is a haematoma that isperinephric and does not exceed the Gerota’s fascia and has a laceration of the renal parenchyma of less than 1cm
What is a grade 3 kidney injury?
More than 1 cm into the renal parenchyma and has no involvement of the urinary system
What is a grade 4 renal injury?
Involvement of the renal collecting system
What is a grade 5 kidney injury?
Complete avulsion of the kidney
What is the golden standard test for renal injury?
CT scan but not readily available in peripheral hospitals so we use IVP
Surgery is indicated for renal injuries when:
- When there is haemodynamic instability
2. Peritonitis
What is the management of a pseudo-aneurysm after trauma to the kidney?
- Resus the patient
- Insert catheter or bladder washout
- Transfuse the patient if necessary
- Do angiogram and embolisation
Treatment of ureteric injuries include:
- JJ stent(left in situ for 6 weeks)
2. Percutaneous nephrostomies
What is extraperitoneal bladder injury?
Bladder injury caused by penetration of bony fragments. Usually associated with pelvic fractures
Where is the bladder located in the adult body?
Extraperitoneally
What covers the bladder dome?
Parietal peritoneum
Define intraperitoneal bladder rupture:
When a patient with a full bladder sustains an injury to the lower abdomen. Usually associated with a large horizontal tear in the dome of the bladder
What is the best radiological test for bladder injuries?
Ascending cystogram(high pressured cystogram)
What does intraperitoneal bladder injury look like radiologically?
It goes intraperitoneally and has a smooth outline
What does extraperitoneal bladder rupture look like radiologically?
It looks like contrast extravasation around the bladder base
What is the management for intra-peritoneal rupture?
Always treated with surgery
Do a laparotomy and suture up the horizontal tear
What is the management for extraperitoneal rupture?
We treat conservatively
Put in catheter for 10 days
Then give AB
Then repeat cystogram
What is the Mx for penetrating trauma?
Usually treated with surgery because it usually involves other organs such as vagina, urethra and bladder neck
What is the Mx for iatrogenic trauma?
Usually treated with surgical repair
What are the clinical signs of bladder rupture in pts?
- History of MVA,assualt or GSW
- They are unable to void
- There is no sign of blood at the external urethral meatus
- When you insert a catheter there is Macroscopic Haematuria
- There is an impalpable bladder
What is the most NB tests to do after bladder rupture?
PV and a rectal exam
Membranous urethra is usually injured with?
Pelvic injuries
The Bulbar urethra is usually injured with?
Direct perineal trauma
What iatrogenic procedures can cause damage to the urethra?
Catheters and resectoscopes
What is the radiological investigation for urethral injury?
Retrograde urethrogram
When do you put in a suprpubic catheter?
When there is complete injury of the urethra
What is the Mx of penetrating urethral injuries?
Always do a retrograde urethrogram
Then do surgical repair
What is the Mx of a blunt urethral injury?
Put in a suprapubic catheter
Then do a descending urethrogram at day 14(put in contrast and allow it to flush down the bladder towards the ureters)
If there is complete injury then a end to end urethroplasty is needed 3-6 months post injury
Name 4 complications of urethral injuries:
- Erectile dysfunction
- Urethral strictures
- Peri-urethral abscesses
- Fourniers gangrene
Fractured penis is associated with:
Tear in the tunica albigunea surrounding the corpus cavernosum
Penile fractures present with 30% of ____
Urethral injuries
What is the classical triad associated with penile tear?
Snapping sound
Rush of pain
Loss of erection
Avulsion of penile skin is seen when:
The patients clothes get stuck in machinery
What investigation do you do to check for scrotal injury?
Scrotal Ultrasound
If large haematocele on ultrasound then the Mx is:
Urgent exploration and drainage of scrotal haematoma and repair testicle if necessary(orchidectomy)
If haematoma is on the scrotal wall and the testis is normal on U/S then:
Treat conservatively with bed rest, analgesia and scrotal elevation
