Urotrauma

Question 1

Indications to image

Answer 1

-Stable blunt trauma patients with GH/MH and systolic BP <90
-Concerning mechanism (rapid decel, flank blow, rib fx, flank ecchymoses, penetrating)
-Suspicion of renal injury - add delayed phase

Question 2

Management of patients with renal parenchymal injury and extravasation

Answer 2

Observe when stable - if avulsion suspected, intervene

Question 3

When should REPEAT imaging be performed for renal trauma patients?

Answer 3

Grade 4+ injury
Clinical signs of complications

Question 4

When should urinary drainage be performed?

Answer 4

stent preferred (NT or drain can be added too)
-Fever
-Enlarging urinoma
-Increasing pain
-Fistula
-Ileus
-Infection

Question 5

Ureteral injury suspicion/management during laparotomy

Answer 5

Directly inspect if no preop imaging
Repair if stable, divert if unstable (NT, ureteral ligation, externalized stent)
Contusion - stent or resection/primary repair
Stent incomplete injuries

Question 6

Stable patients with pelvic trauma and GH - next step

Answer 6

Cystogram

Question 7

Intraperitoneal traumatic bladder injury management

Answer 7

OR

Question 8

Should an SPT be placed if bladder is repaired and a Foley can be left?

Answer 8

Naw

Question 9

blood at the meatus and pelvic trauma

Answer 9

RUG

Question 10

How long do patients with urethral injury need to be monitored?

Answer 10

1 year

Question 11

Psoas hitch steps

Answer 11

Midline incision
Mobilize bladder
Ligate super and middle vesical artery on contralateral side
Fill bladder and pexy to psoas fascia (avoid genfem!)
Spatulate ureter
Make otomy
Sew
Leave catheterWh