Urotrauma Flashcards
Give me AAST scale for renal trauma.
I - subcapsular hematoma
II - < 1 cm parenchymal laceration
III - > 1 cm parenchymal laceration
IV - parenchyma + collecting system (artery or vein injury, but contained)
V - shattered kidney (hilum has avulsed)
What is conservative mgmt for renal trauma patients?
close hemodynamic monitoring, bedrest, ICU admission, blood transfusion as needed,
Which patients do you need to take action?
HDUS, +/-, large perirenal hematoma (4cm), +/- vascular contrast extrav (AAST III-V)
Which patients need follow up imaging?
48 hours for those with IV/V injuries, or worsening clinical symptoms (fevers, worsening flank pain, dropping Hct, abdominal distension)
Which patients require urine drainage?
Stent +/- perc neph +/- urinoma drain
For patients with enlarging urinoma, fevers, ileus, worsening pain, concern for infection
What differs in renal trauma in pediatric patients?
RUS as part of FAST exam - get CT if FAST is abnormal
What is a predictor of persistent bleeding?
arterial blush, siginificant parenchymal depth, large hematoma (esp medial)
What are ways to divert a HDUS patient with ureteral injury?
ligate with perc tube
place externalized ureteral catheter to end of prox ureteral defect
What should be done for delayed ureteral injury finding?
Retrograde stent attempt first - and if not possible PCN
- can go in earlier to fix IF within one week
IF PCN is not enough, place urinoma drain, and if that is not enough, do immediate repair
What is management for ureterovaginal fistula?
Ureteral stent placement. Reimplant if this conservative measure does not work
What is something to consider about ureteral injuries that are unable to get the length needed?
Only utilize boari flap or psoas hitch , do not try using ileal ureter or autotransplant in the trauma settingW
What nerve is most likely to be injured with psoas hitch?
femoral nerve
If called in by outside specialty (gyn), and there is an iatrogenic cystotomy, what else MUST you check?
do retrograde pyelograms or direct visualization of ureters - as often also injured
How is a small VVF usually managed?
if less than 1cm - can try urethral catheterization.
otherwise will need VVF repair with flap
If occurs after radiation - start to consider biopsy to rule out cancer
Causes of fistulas?
foreign body
radiation
infectious
epithelization
neoplasm
distal obstruction
What must you always get if you have pelvic trauma with blood at meatus?
RUG.
if women - direct evaluation w/ speculum or cystoscopy
If there is urethral disruption in a patient with PFUI, what should be done?
SPT - preferably 14 fr and above. Delayed urethroplasty
What to do if the bladder is displaced?
U/S or aspiration with needle to verify where bladder is at.
In any patient with urethral injury, what should be monitored, and for how long?
For the first year - check for urethral stricture formation, as well as ED and incontinence.
Do with uroflow, RUG, cystoscopy, symptom check (questionnaires)
What to do if anterior urethra penetrating trauma?
immediate surgical exploration and primary repair. if unable to get tension free, spatulate ventral aspect and place SPT (no chord)
What if blunt / straddle bulbar urethra injury from straddle?
Place SPT. if RUG shows partial - can gently try urethral catheter.
If you have a urethrocutaneous fistula / (periurethral or perineal) infection, what do you do?
SPT, I&D
What is history to ask patient with concern for penile fracture?
immediate detumescence?
snapping sound?
sex position?
significant ecchymosis
significant swelling
can you pee?
What are optional imaging studies for penile fracture?
Penile U/S or MRI
