Urogenital Trauma

Question 1

The____ are the most commonly injured UG organ

Answer 1

kidneys

Question 2

What are some of the underlying pathological injuries to the kidneys

Answer 2

Hydronephrosis and Tumours

Question 3

What are the 5 factors that protect kidneys

Answer 3

1. Ribcage
2. Posterior abdominal wall
3. Anterior visceral wall
4. Perinephric fat and fascia
5. The fact that kidneys are retroperitoneal

Question 4

Give 3 examples of blunt trauma to the kidneys

Answer 4

1. MVA
2. assault
3. A fall

Question 5

Give 3 examples of penetrating trauma to the kidneys

Answer 5

1. Stab wounds
2. GSW
3. Iatrogenic-PCNL and renal biopsy

Question 6

Define primary haemorrhage

Answer 6

This is bleeding that occurs at the onset of injury

Question 7

Define secondary haemorrhage

Answer 7

This is bleeding that occurs after 10-14 days after the injury. Associated with haematoma that clears up in the renal parenchyma and goes into the collecting ducts

Question 8

Name 4 clinical presentations of renal injury

Answer 8

1. Haematuria
2. Flank, back and loin pain
3. Laceration at the place of injury
4. May have haemorrhagic shock

Question 9

Urine extravasation definition:

Answer 9

A disruption of the urethra that leads to the collection of urine in other cavities such as the scrotum etc.

Question 10

What is grade 1 kidney injury?

Answer 10

This is subcapsular hamaetoma and has no laceration or urinary extravasation

Question 11

What is grade 2 kidney injury?

Answer 11

This is a haematoma that isperinephric and does not exceed the Gerota’s fascia and has a laceration of the renal parenchyma of less than 1cm

Question 12

What is a grade 3 kidney injury?

Answer 12

More than 1 cm into the renal parenchyma and has no involvement of the urinary system

Question 13

What is a grade 4 renal injury?

Answer 13

Involvement of the renal collecting system

Question 14

What is a grade 5 kidney injury?

Answer 14

Complete avulsion of the kidney

Question 15

What is the golden standard test for renal injury?

Answer 15

CT scan but not readily available in peripheral hospitals so we use IVP

Question 16

Surgery is indicated for renal injuries when:

Answer 16

1. When there is haemodynamic instability

2. Peritonitis

Question 17

What is the management of a pseudo-aneurysm after trauma to the kidney?

Answer 17

1. Resus the patient
2. Insert catheter or bladder washout
3. Transfuse the patient if necessary
4. Do angiogram and embolisation

Question 18

Treatment of ureteric injuries include:

Answer 18

1. JJ stent(left in situ for 6 weeks)

2. Percutaneous nephrostomies

Question 19

What is extraperitoneal bladder injury?

Answer 19

Bladder injury caused by penetration of bony fragments. Usually associated with pelvic fractures

Question 20

Where is the bladder located in the adult body?

Answer 20

Extraperitoneally

Question 21

What covers the bladder dome?

Answer 21

Parietal peritoneum

Question 22

Define intraperitoneal bladder rupture:

Answer 22

When a patient with a full bladder sustains an injury to the lower abdomen. Usually associated with a large horizontal tear in the dome of the bladder

Question 23

What is the best radiological test for bladder injuries?

Answer 23

Ascending cystogram(high pressured cystogram)

Question 24

What does intraperitoneal bladder injury look like radiologically?

Answer 24

It goes intraperitoneally and has a smooth outline

Question 25

What does extraperitoneal bladder rupture look like radiologically?

Answer 25

It looks like contrast extravasation around the bladder base

Question 26

What is the management for intra-peritoneal rupture?

Answer 26

Always treated with surgery | Do a laparotomy and suture up the horizontal tear

Question 27

What is the management for extraperitoneal rupture?

Answer 27

We treat conservatively Put in catheter for 10 days Then give AB Then repeat cystogram

Question 28

What is the Mx for penetrating trauma?

Answer 28

Usually treated with surgery because it usually involves other organs such as vagina, urethra and bladder neck

Question 29

What is the Mx for iatrogenic trauma?

Answer 29

Usually treated with surgical repair

Question 30

What are the clinical signs of bladder rupture in pts?

Answer 30

1. History of MVA,assualt or GSW 2. They are unable to void 3. There is no sign of blood at the external urethral meatus 4. When you insert a catheter there is Macroscopic Haematuria 5. There is an impalpable bladder

Question 31

What is the most NB tests to do after bladder rupture?

Answer 31

PV and a rectal exam

Question 32

Membranous urethra is usually injured with?

Answer 32

Pelvic injuries

Question 33

The Bulbar urethra is usually injured with?

Answer 33

Direct perineal trauma

Question 34

What iatrogenic procedures can cause damage to the urethra?

Answer 34

Catheters and resectoscopes

Question 35

What is the radiological investigation for urethral injury?

Answer 35

Retrograde urethrogram

Question 36

When do you put in a suprpubic catheter?

Answer 36

When there is complete injury of the urethra

Question 37

What is the Mx of penetrating urethral injuries?

Answer 37

Always do a retrograde urethrogram | Then do surgical repair

Question 38

What is the Mx of a blunt urethral injury?

Answer 38

Put in a suprapubic catheter Then do a descending urethrogram at day 14(put in contrast and allow it to flush down the bladder towards the ureters) If there is complete injury then a end to end urethroplasty is needed 3-6 months post injury

Question 39

Name 4 complications of urethral injuries:

Answer 39

1. Erectile dysfunction 2. Urethral strictures 3. Peri-urethral abscesses 4. Fourniers gangrene

Question 40

Fractured penis is associated with:

Answer 40

Tear in the tunica albigunea surrounding the corpus cavernosum

Question 41

Penile fractures present with 30% of ____

Answer 41

Urethral injuries

Question 42

What is the classical triad associated with penile tear?

Answer 42

Snapping sound Rush of pain Loss of erection

Question 43

Avulsion of penile skin is seen when:

Answer 43

The patients clothes get stuck in machinery

Question 44

What investigation do you do to check for scrotal injury?

Answer 44

Scrotal Ultrasound

Question 45

If large haematocele on ultrasound then the Mx is:

Answer 45

Urgent exploration and drainage of scrotal haematoma and repair testicle if necessary(orchidectomy)

Question 46

If haematoma is on the scrotal wall and the testis is normal on U/S then:

Answer 46

Treat conservatively with bed rest, analgesia and scrotal elevation