Term
(Genitourinary trauma)
Q. ___ acounts of 80 -90% of all trauma to the upper urinary tract |
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Definition
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Term
| Pt was in a MVA and experienced blunt trauma. You do a CT scan of the upper urinary tract and found blood at the meatus. What is the next test you call for and who do you consult? |
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Definition
Test = retrograte urethrogram
Consult: urology |
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Term
| Adult blunt trauma with no blood in meatus and find microhematuria and patient is not in shock. on x-ray you find a pelvic fracture. what is the next exam you choose to get for this patient? |
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Definition
cystogram. if abnormal consult urology
If no pelvic fracture -- just observe
iF no shock --> consider CT or IVP in major deceleration injury |
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Term
| Patient experienced a stab wound to the penis and is hemodynamically stable. what should you do next? |
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Definition
| urology consult and retrograde urethrogram if positive microscopic or gross hematuria |
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Term
What grade is the following renal injury?
Pt has a renal contusion, intact renal capsule and collecting system |
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Definition
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Term
| what grade is the following renal injury: major laceration greater than 1 cm in depth. collecting system intact |
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Definition
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Term
| Minor laceration, superificial cortical disruption less than 1 cm. collecting system intact is what grade in terms of renal injury? |
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Definition
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Term
| Describe a Grade IV renal injury |
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Definition
| parenchymal laceration extending through the renal cortex, medulla and collecting system; pr main renal artery or vein injury with contained hemorrhage |
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Term
| describe a Grade V renal injury |
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Definition
| completely shattered kidney or avulsion of main renal artery or vein that devascularizes the kidney. AKA pedical injury |
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Term
| How do manage Grade 1, 2 and most of grade 3 renal traumas |
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Definition
| bed rest, serial H/H, repeat X-rays i.e. CT scan; once pt is hemodynamically stable can be managed as an outpatient |
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Term
| you have a patient with a parenchymal lacertion extending through the renal cortex, medulla, and collecting system -- how would you manage this patient? |
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Definition
Patient has a grade IV renal trauma: manage with
stent
renal exploration
nephrectomy ??
autotransplant
also applies to Grave V |
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Term
| How do you diagnose a ureteral injury and what is the most common cause? |
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Definition
diagnosed by contrast study: CT scan, IVP, and or retrograde pylogram.
almost always from a sharp trauma.
most common causes are iatrogenic: ureteroscopy, pelvic surgery and cancer. |
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Term
| What are the signs and symptoms of ureteral injury? |
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Definition
flank pain: 1-21 days
flever >100F
anuria bilateral only
ureterovaginal fistula: 1-30 days
ureterocutaneous fistula: 1-30 days |
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Term
| what is your primary goal in treating a ureteral injury and what are some ways you can establish this goal? |
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Definition
#1: reestablish the flow of urine!!!
ureteric stent
nephrostomy tube
ureteroureterostomy
nephrectomy?? |
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Term
| The bladder is most vulnerable to injury during MVAs, falls, crush injuries, blows to the abdomen when?? |
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Definition
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Term
| What symptom is unavoidable and always present when diagnosing someone with a bladder injury? |
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Definition
| gross hematuria (disrupt bladder lining you are going to get hematuria!) |
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Term
| What is a pathopneumonic finding for bladder injury when using CT scan or cystogram as a imaging modality? |
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Definition
| urinary extravasation (80% of the time is extraperitoneal and 20% of the time is intraperitoneal) |
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Term
| where is the intraperitoneal extravasation located? |
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Definition
| at the dome of the bladder. usually requires surgical repair |
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Term
| posterior urethra includes what parts? |
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Definition
prostate and membranous
anterior = bulbous and pendulous |
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Term
| Patient fell from a hieght and experienced a shearing force of pelvic bone diruption with the prostate and membranous urethra being pulled in opposite directions. If you were to diagnose the following patient with a posterior urethral injury, what would y |
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Definition
1. the patients history!
2. blood per meatus
3. classicly: "high riding prostate"
4. pelvic hematoma
5. retrograde urethrogram would be done prior to catherization!! |
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Term
| How do you treat a posterior urethral injury? |
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Definition
establish urinary drainage! very useful and safe= suprapubic tube (pt.s will later need realignment)
for partial tears - cystoscopy with realignment using foley catheter |
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Term
| What are long term complications following a posterior urethral injury? |
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Definition
incontinence
stricture formation
impotence |
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Term
| Follow up of the long term complications of posterior urethral injuries = |
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Definition
cystoscopy
dilation of strictures
ED therapy if necessary |
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Term
| Most anterior urethral injuries are caused by external violence and blunt trauma to the perineum. how would be work up this patient |
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Definition
diagnose with H/p
retention
blood per meatus
echhymosis of the penis scrotum and/or perineum
retrograde urethragram and cystoscopy important in diagnosis |
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Term
| what are some complications of penile injuries? |
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Definition
| impotency and urethral strictures as well as psychological effects |
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Term
| what test is the most helpful for diagnosing scrotal injuries? |
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Definition
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Term
| how do you treat scrotal hematomas? |
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Definition
| conservatively, most will resolve with time. |
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Term
| t?F most testicular fractures most be removed |
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Definition
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