Kidney & Bladder

Question 1

When should urological injuries be considered??

Answer 1

1. Straddle injury
2. Penetration injury to lower abdomen
3. Fall from heights
4. Gross hematuria
5. Pelvic fracture

Question 2

What organs are mostly injured during pelvic fracture?

Answer 2

• Bladder
• Vagina
• Posterior urethra (men)

Question 3

Manifestation of Urethral injuries

Answer 3

• Blood @ urethral meatus
• Inability to urinate
• High-riding prostate on DRE
• Perineal/ Scrotal hematoma
• Resistance to catheter during catheterization

Question 4

What test must be performed prior to urethral catheterization in the setting of suspected urethral injury?

Answer 4

Retrograde Urethrogram (RUG)
- No disruption - All contrast enter bladder
- Partial disruption - Some contrast enter bladder; some extravagates via urethra
- Complete disruption - no contrast enter bladder; all extravagates

Question 5

Management of bladder &urethral injuries

Answer 5

1. Urinary drainage - Urethral catheter or Suprapubic catheter
2. Open exploration w/ repair - Ant. urethral damage
3. Diversion w/ suprapubic cystostomy –> Urethroplasty in 3-6m - Post. urethral damage

Question 6

Parts of anterior & posterior urethra

Answer 6

Anterior –> Bulbous & Pendulous
Posterior –> Prostatic & Membranous

*Separated by urogenital diaphragm

Question 7

Why is posterior injury management usually delayed?

Answer 7

Allows for anatomic stabilization & thereby avoiding infection with catheterization
- Prostate descend from high-riding position
- Resolution of associated pelvic hematoma

Question 8

Classic presentation of bladder injuries

Answer 8

1. Gross hematuria
2. Suprapubic tenderness
3. Difficulty voiding

Question 9

Evaluation & diagnosis of bladder injuries

Answer 9

Retrograde cystography
- Fill the bladder with >300ml of water-soluble contrast via urinary catheter