Injury, Urinary Retention, Male Infertility, Priapism

Question 1

Indications of surgical management of renal injury

Answer 1

1. Hemodynamic instability
2. Exploration of aasociated structures
3. Explanding or pulsatile hematoma
4. Grade 4 or 5 injury
5. Incidental finding of renal pathology requiring surgery
6. Vascular injury after failed angiographic ttt

Question 2

The two most common sites for bladder injury are……

Answer 2

Gross hematuria and abdominal tenderness

Question 3

Initial management of urethral rupture is…..

Answer 3

Immediate suprapubic tube placement

Question 4

Describe etilogy of urinary retention

Answer 4

1. BOO
2. Drugs, acute infection, precipitating factors
3. Post-opertaive retention after pelvic surgery due to reflex paim or overdistension of bladder after anesthesia
4. Clot retention due to hematuria

Question 5

Describe managent of clot retention

Answer 5

Insertion of triple way 22 or 24 ch catheter to allow evacuation of clots and irrigation of hematuria
PAUS of IVU to detect cause
Cystoscopy to confirm diagnosis

Question 6

Mention indications of urethral catheterization

Answer 6

1. Relief of urinary retention
2. Monitoring urine output and bladder draining following surgery to bladder or prostate
3. After operations where limited movement makes voiding difficult
4. Bladder drainage following injuries

Question 7

Mention indications and contraind of suprapubic catherers

Answer 7

Ind: failure of urethral catheterization OR long-term catheterization which causes hypospasdius in males and pastulous urethra in females
Contra: clot retention (as the cause may be bladder cancer and spread to skin by catheter), lower midline incision bowel may be adherent to bowel leading to perforation (perform US guided. Pelvic fractures to avoid infection of hematoma

Question 8

Imaging modality of choice for renal injury is….., for bladder injury is….., for urethral injury is….., for testicular torsion is…..

Answer 8

PACT with contrast
Cystogram
Retrograde urethrogram
Doppler

Question 9

Describe treatment of priapism if:
1. High flow
2. Low flow

Answer 9

1. Conservative by aspiration of corpora cavernosa followed by irrigation if failed intracavernosal injection of a-adrenergic agonist (phenylepherine). For sickle cell, hydration O2 and alkalinization. Surgery (shunt between corpora cavernosa and glans or spongisum)
2. Observation followed by selective arterial embolization if failed.

Question 10

Mention local causes of male infertility

Answer 10

1. Testicular injury (varicocele, cryptorchidism, mumps)
2. Sperm disorders: sperm Abs or Kartagner
3. Male genital obstruction

Question 11

Mention investigations for male infertility

Answer 11

Semen analysis, hormonal assessment, genetic assessment
Imaging: TRUS
Testicular biopsy to differentiate obstructive from non-obstructive causes of azoospermia also used for sperm retrieval for ICSI

Question 12

Describe management of each type of incotinence

Answer 12

1. SUI: a stimulatants, surgery (injection of bulking agent, urethral slings, artificial sphincter)
2. UUI: anticholinergents or augmentation cystoplasty
3. Overflow I: a blockers, surgery for cause TURP, VIU or urethroplasty for stricture), sphincterotomyin DSD

Question 13

The preferred imaging study for renal injury is……

Answer 13

Contrast-enhanced CR scan

Question 14

What is AMPLE history?

Answer 14

A llergies, M edications, P ast medical history, L ast meal or other intake, and E vents leading to presentation

Question 15

Mention indications for surgical intervention in renal injury

Answer 15

1. Hemodynamic instability
2. Exploration of associated injury
3. Expanding or pulsatile hematoma
4. Grade 4-5 injury
5. Incidental finding of renal abnormality requiring surgical intervention
6. Vascular repair after failed angiographic ttt

Question 16

Extraperitoneal bladder rupture is managed by……, while intraperitoneal…..

Answer 16

Urethral catheter drainage fir 2 wks (conservative)
Surgical exploration & immediate repair

Question 17

MC type of urethral rupture is….

Answer 17

Extra-pelvic

Question 18

Describe etiology of testicular torsion

Answer 18

PDFs: MC inversion of testis, imperfectly descended testis, high investment of tunica vaginalis, spirally attached cremasteric muscle, long mesorchium, separation of epididymis from body of testis
Precipitating factors: sudden straining, mild trauma, spontaneuos

Question 19

Complication of priapism is…..

Answer 19

Low flow leads to ischemia & loss of erectile function

Question 20

Penile fracture is due to disruption of…….

Answer 20

Tunica albuginea