Urinary Tract Injury

Question 1

What percentage of all injuries in emergency involve Genitourinary tract?

Answer 1

10%

Question 2

Initial assessment

Answer 2

Control hemorrhage and shock
Rescucitation as required

Question 3

In severely injured patients

Answer 3

IV lines
Urethral catheter

Question 4

Before catheter insertion

Answer 4

Urethral meatus should be examined for blood

Question 5

Most common injuries of urinary system

Answer 5

Blunt trauma
Gunshot and knife wounds

Question 6

Clinical findings of urinary tract injury

Answer 6

Hematuria
Pain and ecchymosis
Abdominal distention, ileum, nausea, vomiting
Shock
Low rib fractures
Palpable mass

Question 7

Lab investigations

Answer 7

Urinalysis
Hematocrit
RFT

Question 8

Imaging

Answer 8

Abdominal CT with IV contrast

Question 9

Staging of injury

Answer 9

Parenchyma lacerations
Urinary extravasating
Extent of retroperitoneal hematoma
Identifies non viable tissue
Outlines injury to surrounding organs

Question 10

Early complications

Answer 10

Hemorrhage
Urinary extravasating (urinoma), abscess

Question 11

Late complications

Answer 11

Hypertension
Hydronephrosis
AV fistulas, secondary bleed
Calculus formation
Pyelonephritis

Question 12

Emergency measures

Answer 12

Prompt treatment of shock
Complete rescucitation
Evaluate for associated injuries

Question 13

Conservative measures in 85%

Answer 13

Bed rest and hydration
Careful monitoring of BP, Hematocrit, degree of hematuria

Question 14

Surgical measures

Answer 14

Persistent retroperitoneal bleeding
Urinary extravasating
Evidence of non viable renal parenchyma
Renal pedicure injuries

Question 15

Injuries to bladder

Answer 15

External force (ass. With pelvic fractures)
Iatrogenic (gynecologic procedures)

Question 16

Classification of bladder injury

Answer 16

Extraperitoneal (pelvic fracture)
Intraperitoneal (direct blow to low abdomen when bladder is filled)

Question 17

Clinical findings of bladder injury

Answer 17

History of low abdominal trauma
Gross hematuria
Pelvic pain
Shock
Tenderness of suprapubic
Acute abdomen

Question 18

Imaging for bladder injury

Answer 18

Cystography

Question 19

Cystography procedure

Answer 19

Bladder should be filled with 300 ml of contrast
Intraperitoneal or extraperitoneal extravasation of contrast

Question 20

Complications of bladder injury

Answer 20

Pelvic abscess
Peritonitis
Partial incontinence

Question 21

Conservative measures for bladder injury

Answer 21

Extraperitoneal bladder rupture managed with catheter only

Question 22

Intraperitoneal bladder rupture tx

Answer 22

Transperitoneal surgery

Question 23

Most important sign of urethral injury

Answer 23

Blood at urethral meatus

Question 24

Clinical findings of urethral injury

Answer 24

History of trauma
Bleeding from urethra
Perineal pain hematoma
Inability to void
Normal DRE

Question 25

Imaging for urethral injury

Answer 25

Retrograde urethrogram , extravasation of contrast material at site of injury

Question 26

Complications of urethral injury

Answer 26

Heavy bleeding Urinary extravasation leading to sepsis Stricture

Question 27

General measure for urethral injury

Answer 27

Heavy bleed—-> local pressure followed by rescucitation

Question 28

Specific measures for urethral injury

Answer 28

Percutaneous suprapubic cystostomy Wait 2-3 wks before voiding study through suprapubic catheter

Question 29

Healing at site of urethral injury may result in

Answer 29

Stricture formation

Question 30

Treatment of urethral stricture

Answer 30

Delayed open reconstruction

Question 31

When pelvic fractures occur from blunt trauma, membranous urethra is sheared from

Answer 31

Prostatic apex at the prostatomenbranous junction

Question 32

Clinical findings of posterior urethral injury

Answer 32

History of crushing injury to pelvic with lower abdominal pain and inability to urinate and Suprapubic tenderness with pelvic fracture and rectal examination reveal large hematoma with prostate displaced superiorly blood at meatus

Question 33

Complications of posterior urethral injury

Answer 33

Stricture Impotence Incontinence

Question 34

Immediate management of posterior urethral injury

Answer 34

Suprapubic cystostomy

Question 35

Treatment of posterior urethral injury

Answer 35

Delayed urethral reconstruction