Uro Trauma

Front 1

How are penile fractures managed?

Back 1

- prompt (within 8 hours is best) surgical exploration and repair using a distal circumcising incision and closure of the tunical defect with interrupted 2-0 or 3-0 absorbable suture;
- debridement of the delicate underlying erectile tissue must be avoided
- for concomitant urethral injuries, repair with fine absorbable suture over a catheter and give broad spectrum antibiotics

Front 2

How often is a urethral injury associated with penile fracture? What test should be performed when this is suspected?

What imaging can you do?

Back 2

- 38% of the time
- RUG
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MRI and not ultrasound *(not diagnostic)

Front 3

Which type of bite injury should be closed primarily?

Back 3

- dog, but not human bites. give broad-spectrum antibiotics

Front 4

T/F: In the presence of a normal ultrasound, it is not necessary to surgically explore the site of injury?

How should testicular rupture be managed?

Back 4

-False: ultrasound is highly operator-dependent, resulting in high percentage of false-negative rates.
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- Early (<3d) exploration and repair as this is associated with increased testis salvage, and preservation of fertility and hormonal function
- Blunt trauma - 90% success rate
- Penetrating trauma - 32-65% success
- Nonoperative management – 3-8x orchiectomy rate & ~50% will ultimately undergo surgery for pain, infection, or hematoma

Front 5

Should a hematocele alone be explored in the trauma setting?

Can a patient with a solitary testis play sports?

Back 5

- usually yes, as 80% of operative explorations will find testicular rupture
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- unqualified yes from American Academy of Pediatrics. Tell them to wear a cup. See AUA Update from 2011

Front 6

What are some principles of penile skin loss repair?

Back 6

- use thick, non-meshed split thickness skin graft usually from anterior thigh
- be sure and remove any remaining subcoronal skin as failure to do so can cause circumferential lymphedema
- this skin never regains sensation, although glans usually retains sensation

Front 7

What are some principles of scrotal skin loss repair?

Back 7

- lesions with < 50% skin loss can usually be closed primarily
- for larger skin loss, can place testicles in a thigh pouch or cover with wet dressings for several weeks before repair. Don’t use thigh pouches until infection stabilized b/c risk transmission of infection.
- use meshed STSG and sew spermatic cords together to prevent bifid neoscrotum

Front 8

What are bladder injuries commonly associated with?

What are some signs/symptoms associated with bladder injury?

What is the most reliable sign of bladder injury during trauma?

Back 8

pelvic fracture; 6-10% of pelvic fractures will have an associated bladder rupture; conversely 80-100% of bladder ruptures have a concomitant pelvis fracture
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- gross hematuria: present in 95-100% of bladder injury patients and associated with more significant injuries (bladder rupture), whereas microhematuria (>30 rbcs/hpf) has been more commonly seen in patients with bladder contusion.
- abdominal tenderness/distension, inability to void, bruising over suprapubic region, perineal/scrotal swelling, clots in urine, preexisting bladder disease/surgery

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- gross hematuria
- if blood at meatus or catheter doesn't pass, then get RUG because of association with urethral injury (urethral injuries seen in 10-29% bladder ruptures).

Front 9

What duo of findings mandates immediate cystography after blunt external trauma?

What other types of injuries mandate cystography in the setting of microscopic hematuria?

Back 9

- gross hematuria and pelvic fracture (29% these have bladder rupture)
- relative indications: gross hematuria without a pelvic fracture, microscopic hematuria with a pelvic fracture, microscopic hematuria alone
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- penetrating buttock, pelvic, or lower abdominal trauma