Urologic Trauma Flashcards
Most common organ involved in génito-urinary trauma
Kidney
Type of injury in genitourinary system
Penetrating
Blunt
Location of injuries that should alert about possible renal injury
Upper abdomen
Lower chest
Which part of the body should be immmobilized in trauma until confirmed intact by radiography
Cervical spine immobilization
Signs during examination that suggest possible renal injury
Flank hematoma
Abdominal/ flank tenderness
Rib fractures
Penetrating injuries to low thorax
Grade of kidney injury in trauma
Grade I - subscapular I Hematoma or contusion
Grade II- Perirenal hematoma
Grade III- Vascular injury or active hemorrhage confined to perinephric facia
Grade IV- segmental vein or artery injury, Laceration with pelvic involvement, Active bleed beyond perinephric fascia, segMental or complete infarct
Grade V- Shattered kidney, lacerated artery or vein, desvascularized kidney with acute bleeding
Imaging used to facilitate Reppy diagnosis of intra-abdominal injuries
Sonography at high frequency
See guide for renal injuries
Common causes of ureteral injuries
External trauma
open surgery
laparoscopy
endoscopic procedures
Intraoperative suture ligation
sharp incision and transection
avulsion
devascularization
heat
Freezing
See grading of ureter injury
2 types bladder injuries
Extraperitoneal bladder injury
intraperitoneal injuries
Main cause of extraperitoneal bladder injury
Pelvic fracture
Main cause of intraperitoneal
penetrating injury, burst injuries due to blow to a full bladder
pelvic fracture
Management bladder injury
Immediate catheterization in blunt bladder rupture
Retrograde urethrography if Blood at meatus or catheter does not pass easily
Clinical indication of bladder injury
Suprapubic pain or tenderness
free intraperitoneal fluids on ct or ultrasound examination
inability to void/ low urine output
Clots in urine
clots in bladder on CT
Enlarged scrotum with ecchymoses
abdominal distention or ileus
What is the treatment of uncomplicated extraperitoneal bladder rupture with ideal conditions
Conservative management with urethral catheter drainage alone
Management of penetrating or intraperitoneal injuries due to external trauma
Immediate operative repair
Causes of urethral injuries
In multisystem trauma from vehicular accidents , falls, or industrial accidents
What is the triad of urethral disruption
Blood at meatus
inability to urinate
palpably full bladder
Management of urethral disruption
Do not do urethral catheterization
Diversion of urine using formal cystostomy
delayed urethral reconstruction with anastomotic urethroplasty
Penile fracture definition
Description of Tunica albuginea with rupture of corpus cavernosum
Main cause of penile fracture
Vigorous sexual intercourse
masturbation
running over or falling onto the erect penis
Diagnosis of penile fracture
History of cracking or popping sound
Pain
rapid détumescence
discoloration and swelling of penile shaft
Other forms of penile trauma
Animal or human bites
genital self mutilation
zipper injuries
