230 GU trauma

Question 1

When do you generally use an operative approach vs. a nonoperative approach for renal trauma?

Answer 1

operative: only when hemodynamically unstable

Question 2

What are indications for imaging in renal trauma?

Answer 2

flank/abdominal penetrating trauma
blunt trauma with gross hematuria
blunt trauma with microhematuria + shock
deceleration injuries
pediatric injury with any hematuria

Question 3

What are the indications for renal exploration?

Answer 3

life threatening bleeding
UPJ rupture
renal pedicle avulsion
expanding retroperitoneal hematoma

Question 4

What is the main consequence of deceleration injuries?

Answer 4

deceleration: avulsion of ureter at UPJ

Question 5

How are blunt and penetrating ureteral injuries evaluated?

Answer 5

contrast CT (may see no contrast from one kidney, dilated pelvis/calyces, perfused parenchyma, perinephric urine collection)
retrograde pyelogram

Question 6

How are blunt and penetrating ureteral injuries managed?

Answer 6

IR drainage of fluid collection

percutaneous nephrostomy tube repair (uretero-ureterostomy)

Question 7

What are the cystogram findings of an intraperitoneal vs. extraperitoneal bladder trauma?

Answer 7

intraperitoneal: diffuse contrast uptake in abdomen, lining bowel loops
extraperitoneal: contrast is contained, does not track upward

Question 8

How are intraperitoneal bladder ruptures managed?

Answer 8

surgery

Question 9

How are extraperitoneal bladder ruptures managed?

Answer 9

catheter if uncomplicated

surgery if complicated (ex. bladder neck injury, bone in bladder, rectal injury, vaginal injury)

Question 10

How does urethral trauma present?

Answer 10

blood at the meatus post-injury site (anterior vs. posterior divided at membranous urethra)

Question 11

How is blunt vs. penetrating trauma to the urethra managed?

Answer 11

anterior blunt = catheter drainage
anterior penetrating = surgical repair
posterior blunt = endoscopic alignment or suprapubic tuber diversion with delayed surgical repair

Question 12

What is the presentation of scrotal injury?

Answer 12

firm hemiscrotum with tender testicle or ecchymosis + significant pain

Question 13

What is in the differential when considering scrotal injury?

Answer 13

torsion, epididymo-orchitis, hernia, hydrocele/spermatocele/varicocele, tumor

Question 14

What is the treatment for scrotal trauma?

Answer 14

surgical repair and debridement

Question 15

What is the mechanism of blunt penile trauma?

Answer 15

tunica albuginea thins (especially during erection) and blunt trauma shears the tunica
this leads to a sudden increase in intracavernosal pressure

Question 16

What is the presentation of blunt penile trauma?

Answer 16

popping sound, acute pain/swelling, eggplant deformity, rapid detumescence, hematuria

Question 17

How is blunt penile trauma diagnosed and managed?

Answer 17

retrograde urethrogram –> diffuse contrast extravasation within corpus cavernosum

treat with surgical exploration and repair

Question 18

What is a possible complication of penetrating penile injury?

Answer 18

Urethral stricture development

Question 19

How is urethral injury associated with blunt pelvic trauma managed?

Answer 19

placement of a suprapubic catheter

Question 20

What are the indications for operative exploration following blunt scrotal trauma?

Answer 20

suspected rupture of the tunic albuginea