Urinary Tract Trauma Flashcards
1
Q
Basic facts
A
- Most bladder injuries occur due to blunt trauma
- 85% associated with pelvic fractures
- Easily overlooked during assessment in trauma
- Up to 10% of male pelvic fractures associated with urethral or bladder injuries
2
Q
What are the 3 main different types of urinary tract injury?
A
- Urethral
- External genitalia
- Bladder
3
Q
Urethral injury occurs mainly in males. What does it often present with?
A
Blood at the meatus (50%)
4
Q
What are the two types of urethral injury?
A
- Bulbar rupture
- Membranous rupture
5
Q
What is bulbar rupture?
A
- Most common
- Straddle type injury eg. bicycles
- Triad → urinary retention / perineal haematoma / blood at meatus
6
Q
What is membranous rupture?
A
- Extra or intraperitoneal
- Commonly due to pelvic fracture
- Penile or perineal oedema/haematoma
- PR → prostate displaced upwards
7
Q
Which investigation for urethral injury?
A
Ascending urethrogram
8
Q
What is the management for urethral injury?
A
Suprapubic catheter (surgical placement, not percutaneously)
9
Q
What are causes of external genitalia injuries?
A
- Penetration
- Blunt trauma
- Continence devices
- Sexual pleasure-enhancing devices
- Mutilation
10
Q
What are featuers of bladder injury?
A
- Rupture intra or extra peritoneal
- Presents w/ haematuria or suprapubic pain
- Hx of pelvic # + inability to void → always suspect bladder or urethral injury
- Inability to retrieve all fluid used to irrigate bladder through a Foley catheter indicates bladder injury
11
Q
Which investigation for bladder injury?
A
IVU or cystogram
12
Q
What is the management of bladder injury?
A
- Intraperitoneal → laparotomy
- Extraperitoneal → conservative
