Trauma

Question 1

What is the incidence of urinary tract trauma?

Answer 1

10%

Question 2

How common is renal trauma?

Answer 2

1-5% of all trauma

Question 3

What is the male to female ratio when it comes to urogenital trauma?

Answer 3

3:1

Question 4

How effective are airbags when it comes to renal trauma?

Answer 4

decreases renal injuries by 40-50%

Question 5

How common is renal vasculary injury in renal trauma?

Answer 5

<5%

Question 6

What are the indication for imaging in renal trauma?

Answer 6

Blunt trauma:
gross hematuria
microhematuria + hypotension
rapid desceleration injuries

Penetrating trauma:
all with hematuria
clinical suspicion (inlet or exit wound)

Question 7

What laboratory tests should be performed on a patient who has suffered renal trauma?

Answer 7

Urine
Hematocrit
Creatinine (8 hrs before change can be measured)

Question 8

When should on shot intraoperative IVP be used?

Answer 8

In those, unstable, subjected to laparotomy
to see the condition of the contralateral kidney

2 ml/kg contrast, single x-ray after 10 min

Question 9

What is importernt to remember when performing a CT on a patient with a suspected urinary tract injury?

Answer 9

2 phase study

both a vascular phase and a
delayed phase afte 10 min to look for peri-renal or ureteral contrast extravasation

Question 10

When should you use an MRI to evaluate a patient with suspected urinary tract injury?

Answer 10

CT is not availabel
Iodine allergy
CT findings are equivocal

Question 11

When is angiography indicated for a patient with suspected urinary tract injury?

Answer 11

stable patient when therapeutic angio-embolization is needed
or
non enhanced cortex on CT-scan (suspection of total avulsion, renal artery thrombosis or severe concussion causing vascular spasm)

Question 12

Renal score AAST Grade 1:

Answer 12

contusion or subcapsular hematoma

Question 13

Renal score AAST Grade 2:

Answer 13

Cortical laceration <1 cm no extra-vasation

Question 14

Renal score AAST Grade 3:

Answer 14

Cortical laceration >1 cm no extra-vasation

Question 15

Renal score AAST Grade 4:

Answer 15

Laceration > 1cm with injury to the collecting system
and/or
Thrombosed artery or segmental vein injury

Question 16

Renal score AAST Grade 5:

Answer 16

Shattered kidney
and/or
Renal pedicle avulsion

Question 17

Indication for renal exploration:

Answer 17

continues hemodyamic instability (in spite of resuscitation)
expanding retroperitoneal hematoma
pre-existing abnormality (hydronephrosis, tumour)

Question 18

What is the treatment when PNL has caused trauma to the colon?

Answer 18

Liberal drainage of the PCS
Keep the tube in the perinephric and pericolic spaces 
Antibiotics
Stop oral feedings for 5 days
Success rate is very high

Question 19

What is the most common cause of ureteral trauma?

Answer 19

Iatrogenic 75%
blunt 18%
penetrating 7%

Question 20

What type of iatrogenic trauma is most common?

Answer 20

Gynecologic 70%
General surgery 14%
Urology 16%

Question 21

Ureteral trauma AAST Grade 1:

Answer 21

hematoma and/or contusion

Question 22

Ureteral trauma AAST Grade 2:

Answer 22

laceration < 50% of circumference

Question 23

Ureteral trauma AAST Grade 3:

Answer 23

laceration > 50% of circumference

Question 24

Ureteral trauma AAST Grade 4:

Answer 24

complete tear < 2 cm loss

Question 25

Ureteral trauma AAST Grade 5:

Answer 25

complete tear ≥ 2 cm loss

Question 26

How often is an injury to the ureter overlooked?

Answer 26

60%

Question 27

What can be symptoms that leads to a late diagnosis of ureteral injury?

Answer 27

``` Leakage Acute obstruction Sepsis Uro-ascites Urinoma Fistula ```

Question 28

When should surgical repair of a urethral injury be undertaken?

Answer 28

Within one week or after 2-3 months

Question 29

Examples of surgical techniques for re-continuity of urethers:

Answer 29

end to end anastomosis Transuretero-ureterostomy Uretero-calycostomy Boari flap ± psoas hitch Auto transplantation Ileal segment interposition

Question 30

What is the most common cause of bladder trauma?

Answer 30

70-80% due to pelvic fracture

Question 31

Symptoms of bladder injury: | + symptoms of silent rupture

Answer 31

Hematuria Pain No desire or inability to void Urine leak and/or blood through the vagina ``` in silent rupture: ileus ascites peritonitis uremia sepsis toxemia ```

Question 32

Bladder trauma AAST Grade 1:

Answer 32

concussion, intramural hematoma partial thickness

Question 33

Bladder trauma AAST Grade 2:

Answer 33

extra peritoneal rupture < 2 cm

Question 34

Bladder trauma AAST Grade 3:

Answer 34

extra peritoneal rupture > 2 cm or intra peritoneal rupture < 2 cm

Question 35

Bladder trauma AAST Grade 4:

Answer 35

Intraperitoneal rupture ≥ 2 cm

Question 36

Bladder trauma AAST Grade 5:

Answer 36

extra or intra peritoneal laceration extending into the bladder neck or trigone

Question 37

Radiological diagnosis of bladder trauma:

Answer 37

Retrograde gravity cystography (also excludes urethral trauma) CT can be used especially if other trauma is present

Question 38

When is surgical repair indicated in bladder trauma?

Answer 38

Intraperitoneal rupture or extraperitoneal rupture when drainage is not guaranteed or surgery is indicated for other injuries

Question 39

Postoperative care after surgical treatment of bladder injury:

Answer 39

Antibiotics Catheter 10 days Retrograde cystogram before catheter removal (if leakage, catheter for another 5 days)

Question 40

Penile trauma AAST Grade 1:

Answer 40

Cutaneous laceration or contusion

Question 41

Penile trauma AAST Grade 2:

Answer 41

Laceration of Buck's fascia (cavernosum) withour tissue loss

Question 42

Penile trauma AAST Grade 3:

Answer 42

Cutaneous avulsion, laceration through glans or meatus | or cavernosal or urethral defect < 2cm

Question 43

Penile trauma AAST Grade 4:

Answer 43

partial penectomy | or cavernosal or urethral defect ≥ 2 cm

Question 44

Penile trauma AAST Grade 5:

Answer 44

total penectomy

Question 45

What is the most common cause of posterior urethral trauma?

Answer 45

pelvic fracture present i 4-14 % of pelvic fracture cases males>females

Question 46

How often is posterior urethral injury associated with bladder rupture?

Answer 46

10-17%

Question 47

How common is urethro-rectal fistula after posterior urethral injury?

Answer 47

up to 8%

Question 48

What clinical signs should arise suspicion of posterior urethral injury?

Answer 48

Blood at the meatus Inability to urinate Full bladder

Question 49

Urethral injury AAST Grade 1:

Answer 49

Contusion: blood at the meatus

Question 50

Urethral injury AAST Grade 2:

Answer 50

Stretch injury: elongation of the urethra without extravasation

Question 51

Urethral injury AAST Grade 3:

Answer 51

Partial disruption: extravasation at injury site with bladder visualization

Question 52

Urethral injury AAST Grade 4:

Answer 52

Complete disruption: Extravasation at the injury site without bladder visualization < 2 cm urethral separation

Question 53

Urethral injury AAST Grade 5:

Answer 53

Complete disruption: Complete transection with ≥ 2 cm separation or extension to the prostate of vagina

Question 54

How do you confirm an urethral injury?

Answer 54

Urethrography

Question 55

What options are there when it comes to the timing of surgical treatment for an urethral injury?

Answer 55

Immediate: < 48H Delayed: 2 days- 2 weeks Deferred: > 3 months

Question 56

How should a complete posterior urethral rupture be treated?

Answer 56

Immediate realignment (with catheter for 4-8 weeks) then Deferred urethroplasty sucessrate 80-98%

Question 57

What are the most common complications from posterior urethral injuries?

Answer 57

Impotence | Incontinence

Question 58

How should you treat Anterior Urethral Trauma?

Answer 58

Open repair over catheter alignment | or suprapubic tube without repair

Question 59

What kind of trauma can cause Anterior Urethral injury?

Answer 59

Straddel injury Sexual intercourse Gunshots Iatrogenic trauma