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Urology > Urogenital Trauma > Flashcards

Urogenital Trauma Flashcards

1
Q

The____ are the most commonly injured UG organ

A

kidneys

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2
Q

What are some of the underlying pathological injuries to the kidneys

A

Hydronephrosis and Tumours

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3
Q

What are the 5 factors that protect kidneys

A
  1. Ribcage
  2. Posterior abdominal wall
  3. Anterior visceral wall
  4. Perinephric fat and fascia
  5. The fact that kidneys are retroperitoneal
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4
Q

Give 3 examples of blunt trauma to the kidneys

A
  1. MVA
  2. assault
  3. A fall
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5
Q

Give 3 examples of penetrating trauma to the kidneys

A
  1. Stab wounds
  2. GSW
  3. Iatrogenic-PCNL and renal biopsy
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6
Q

Define primary haemorrhage

A

This is bleeding that occurs at the onset of injury

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7
Q

Define secondary haemorrhage

A

This is bleeding that occurs after 10-14 days after the injury. Associated with haematoma that clears up in the renal parenchyma and goes into the collecting ducts

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8
Q

Name 4 clinical presentations of renal injury

A
  1. Haematuria
  2. Flank, back and loin pain
  3. Laceration at the place of injury
  4. May have haemorrhagic shock
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9
Q

Urine extravasation definition:

A

A disruption of the urethra that leads to the collection of urine in other cavities such as the scrotum etc.

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10
Q

What is grade 1 kidney injury?

A

This is subcapsular hamaetoma and has no laceration or urinary extravasation

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11
Q

What is grade 2 kidney injury?

A

This is a haematoma that isperinephric and does not exceed the Gerota’s fascia and has a laceration of the renal parenchyma of less than 1cm

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12
Q

What is a grade 3 kidney injury?

A

More than 1 cm into the renal parenchyma and has no involvement of the urinary system

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13
Q

What is a grade 4 renal injury?

A

Involvement of the renal collecting system

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14
Q

What is a grade 5 kidney injury?

A

Complete avulsion of the kidney

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15
Q

What is the golden standard test for renal injury?

A

CT scan but not readily available in peripheral hospitals so we use IVP

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16
Q

Surgery is indicated for renal injuries when:

A
  1. When there is haemodynamic instability

2. Peritonitis

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17
Q

What is the management of a pseudo-aneurysm after trauma to the kidney?

A
  1. Resus the patient
  2. Insert catheter or bladder washout
  3. Transfuse the patient if necessary
  4. Do angiogram and embolisation
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18
Q

Treatment of ureteric injuries include:

A
  1. JJ stent(left in situ for 6 weeks)

2. Percutaneous nephrostomies

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19
Q

What is extraperitoneal bladder injury?

A

Bladder injury caused by penetration of bony fragments. Usually associated with pelvic fractures

20
Q

Where is the bladder located in the adult body?

A

Extraperitoneally

21
Q

What covers the bladder dome?

A

Parietal peritoneum

22
Q

Define intraperitoneal bladder rupture:

A

When a patient with a full bladder sustains an injury to the lower abdomen. Usually associated with a large horizontal tear in the dome of the bladder

23
Q

What is the best radiological test for bladder injuries?

A

Ascending cystogram(high pressured cystogram)

24
Q

What does intraperitoneal bladder injury look like radiologically?

A

It goes intraperitoneally and has a smooth outline

25
Q

What does extraperitoneal bladder rupture look like radiologically?

A

It looks like contrast extravasation around the bladder base

26
Q

What is the management for intra-peritoneal rupture?

A

Always treated with surgery

Do a laparotomy and suture up the horizontal tear

27
Q

What is the management for extraperitoneal rupture?

A

We treat conservatively
Put in catheter for 10 days
Then give AB
Then repeat cystogram

28
Q

What is the Mx for penetrating trauma?

A

Usually treated with surgery because it usually involves other organs such as vagina, urethra and bladder neck

29
Q

What is the Mx for iatrogenic trauma?

A

Usually treated with surgical repair

30
Q

What are the clinical signs of bladder rupture in pts?

A
  1. History of MVA,assualt or GSW
  2. They are unable to void
  3. There is no sign of blood at the external urethral meatus
  4. When you insert a catheter there is Macroscopic Haematuria
  5. There is an impalpable bladder
31
Q

What is the most NB tests to do after bladder rupture?

A

PV and a rectal exam

32
Q

Membranous urethra is usually injured with?

A

Pelvic injuries

33
Q

The Bulbar urethra is usually injured with?

A

Direct perineal trauma

34
Q

What iatrogenic procedures can cause damage to the urethra?

A

Catheters and resectoscopes

35
Q

What is the radiological investigation for urethral injury?

A

Retrograde urethrogram

36
Q

When do you put in a suprpubic catheter?

A

When there is complete injury of the urethra

37
Q

What is the Mx of penetrating urethral injuries?

A

Always do a retrograde urethrogram

Then do surgical repair

38
Q

What is the Mx of a blunt urethral injury?

A

Put in a suprapubic catheter
Then do a descending urethrogram at day 14(put in contrast and allow it to flush down the bladder towards the ureters)
If there is complete injury then a end to end urethroplasty is needed 3-6 months post injury

39
Q

Name 4 complications of urethral injuries:

A
  1. Erectile dysfunction
  2. Urethral strictures
  3. Peri-urethral abscesses
  4. Fourniers gangrene
40
Q

Fractured penis is associated with:

A

Tear in the tunica albigunea surrounding the corpus cavernosum

41
Q

Penile fractures present with 30% of ____

A

Urethral injuries

42
Q

What is the classical triad associated with penile tear?

A

Snapping sound
Rush of pain
Loss of erection

43
Q

Avulsion of penile skin is seen when:

A

The patients clothes get stuck in machinery

44
Q

What investigation do you do to check for scrotal injury?

A

Scrotal Ultrasound

45
Q

If large haematocele on ultrasound then the Mx is:

A

Urgent exploration and drainage of scrotal haematoma and repair testicle if necessary(orchidectomy)

46
Q

If haematoma is on the scrotal wall and the testis is normal on U/S then:

A

Treat conservatively with bed rest, analgesia and scrotal elevation

Urology (10 decks)

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