SM_230b: Genitourinary Trauma

Question 1

Degree of hemature ___ correlate with degree of injury in penetrating trauma

Answer 1

Degree of hemature does NOT correlate with degree of injury in penetrating trauma

Question 2

Describe indications for radiologic assessment of genitourinary trauma

Answer 2

Indications for radiologic assessment of genitourinary trauma

• Flank / abdominal penetrating trauma
• Blunt trauma with gross hematuria
• Blunt trauma with microhematuria and shock
• Deceleration injuries
• Pediatric injuries with any hematuria

Question 3

Describe absolute indications for renal exploration following trauma

Answer 3

Absolute indications for renal exploration following trauma

• Life threatening bleeding
• UPJ rupture
• Renal pedicle avulsion
• Expanding retroperitoneal hematoma

Question 4

Describe fascias in the retroperitoneum

Answer 4

Fascias in the retroperitoneum

Question 5

Angioembolization is used for ___

Answer 5

Angioembolization is used for major injuries (renal ruptures / shattered kidneys / pedicle avulsions)

Question 6

Describe key points of renal trauma

Answer 6

Renal trauma

Question 7

Cystogram allows differentiation of ____

Answer 7

Cystogram allows differentiation of extra vs intraperitoneal injury

• Gravity cystogram: contrast, pre and post drainage films, fluoroscopy
• Gross hematuria in hemodynamically stable patient following pelvic trauma requires a retrograde cystogram

Question 8

Describe management of bladder injury

Answer 8

Management of bladder injury

• Uncomplicated extraperitoneal injury: urethral catheter drainage alone
• Complicated extraperitoneal injury (bladder neck injury, bone spicule in bladder, rectal injury, vaginal injury): surgical repair
• Intraperitoneal injury (trauma or iatrogenic): surgical repair

Question 9

Retrograde urethrography should be performed in patients with ___

Answer 9

Retrograde urethrography should be performed in patients with blood at the urethral meatus after pelvic trauma

• Retrograde injection of contrast under fluoroscopy
• Diagnosis of urethral injury
• Diagnosis of location of urethral pathology (anterior vs posterior)

Question 10

Anterior urethra has ____, ____, and ____ sections

Answer 10

Anterior urethra has fossa navicularis, penile, and bulbar sections

Question 11

Posterior urethra has ____ and ____ sections

Answer 11

Posterior urethra has prostatic and membranous sections

Question 12

Posterior urethra can be injured in pelvic fracture related urethral injury because ___

Answer 12

Posterior urethra can be injured in pelvic fracture related urethral injury because fractured pubic bone and anchored prostate tear away from membranous urethra

Question 13

Do not place a Foley catheter unless ___ has been ruled out

Answer 13

Do not place a Foley catheter unless urethral injury has been ruled out

Question 14

Trauma to anterior urethra is treated with ___

Answer 14

Trauma to anterior urethra is treated with immediate repair

(urethral catheter drainage if blunt trauma)

Question 15

Trauma to posterior urethra is treated with ____

Answer 15

Trauma to posterior urethra is treated with suprapubic diversion and delayed repair

Question 16

Penile fracture occurs when ____, ____, or ____

Answer 16

Penile fracture occurs when tunica albuginea thins out during erection, blunt trauma shears tunica, or there is a sudden increase in intracavernosal pressure

Question 17

Penile fracture presents as ____, ____, ____, ____, and ____

Answer 17

Penile fracture presents as popping sound, acute penile pain and swelling, eggplant deformity, rapid detumesence, and ± hematuria

Question 18

Tunica albuginea ____ in diameter during erection which causes an ____ in pressure

Answer 18

Tunica albuginea decreases in diameter during erection which causes an increase in pressure

Question 19

Penile fracture occurs due to ___, ___, or ___

Answer 19

Penile fracture occurs due to coitus, masturbation, or freak accidents

Question 20

Penile fracture is treated with ____

Answer 20

Penile fracture is treated with penile exploration

Question 21

Blunt trauma to penis should make you suspect ____

Answer 21

Blunt trauma to penis should make you suspect penile fracture

Question 22

Penetrating penile trauma is treated with ____ or ____

Answer 22

Penetrating penile trauma is treated with surgical exploration (deglove, irrigate, debride) or conservative management (only if superficial or tangential)

Question 23

Penile amputation involves ____

Answer 23

Penile amputation involves replantation with microvascular reanastamosis

Question 24

Evaluate the urethra after penile injury if ____, ____, or ____

Answer 24

Evaluate the urethra after penile injury if hematuria, unable to void, or blood at meatus

Question 25

Describe differential diagnosis for scrotum injury

Answer 25

Differential diagnosis for scrotum injury

• Trauma: testis rupture, hematocele
• Torsion: testicle, appendix testis, and epididymis
• Epididymo-orchitis
• Hernia
• Hydrocele, spermatocele, varicocele
• Tumor

Question 26

Blunt scrotal trauma presents as ____ and involves ____, ____, and ____ on physical exam

Answer 26

Blunt scrotal trauma presents as significant pain and involves firm scrotum, tender scrotum, and ecchymosis on physical exam

• Testis entrapped against bony structure
• 50 kg force to cause rupture

Question 27

____ is ultrasound finding indicating testicular rupture

Answer 27

Heterogeneous echo pattern within testicular parenchyma with loss of contour is ultrasound finding indicating testicular rupture

Question 28

____ is optimal for blunt scrotal trauma

Answer 28

Timely surgical exploration is optimal for blunt scrotal trauma

• Highest salvage rate
• Hematocele is > 5 cm in size

Question 29

Ureteral trauma management involves ___ and ___

Answer 29

Ureteral trauma management involves IR drainage of fluid collection and urinary drainage via ureteral stent or percutaneous nephrostomy

Question 30

___ or ___ can damage the ureter

Answer 30

Avulsion of the ureter or rapid deceleration injury can damage the ureter

Question 31

____ is the imaging modality to assess suspected ureteral injury

Answer 31

IV contrast CT is the imaging modality to assess suspected ureteral injury

Question 32

Ureteral injury is usually associated with ____ so manage with ____ and ____

Answer 32

Ureteral injury is usually associated with other life-threatening injuries so manage with urinary drainage and delayed repair

Question 33

Endoscopic ureteral injuries (iatrogenic) should be managed with ____ and / or ____

Answer 33

Endoscopic ureteral injuries (iatrogenic) should be managed with ureteral stent and / or percutaneous nephrostomy tube