Trauma 6

Trauma Management in Urology and Obstetrics

• IVP can be used to assess the contralateral kidney's functionality before immediate surgery without an abdominal CT scan
• Left renal vein can be ligated near the IVC and has adrenal and gonadal vein collaterals, while the right renal vein does not
• 95% of renal injuries are treated nonoperatively and not all urine extravasation injuries require surgery
• Bladder trauma is often associated with pelvic fractures and can be indicated by hematuria, meatal blood, or sacral/scrotal hematoma
• Ureteral trauma is most commonly caused by penetrating injuries and requires different management approaches based on the location and extent of the injury
• Urethral trauma is typically associated with blunt trauma and can be diagnosed using a retrograde urethrogram
• Trauma management during pregnancy involves prioritizing the mother's life, estimating pregnancy based on fundal height, and identifying indicators of fetal maturity
• Placental abruption can result in fetal death and is often caused by shock or mechanical forces
• Uterine rupture is more likely to occur in the posterior fundus and may require aggressive resuscitation, especially if it happens after delivery
• Indications for C-section during exploratory laparotomy for trauma include persistent maternal shock, pregnancy near term, and mechanical limitation to life-threatening vessel injury
• Trauma to the genitalia can result in fractures in the erectile bodies and testicular trauma, which may require repair if necessary
• Management of ureteral injuries includes using IV indigo carmine or IV methylene blue to check for leaks and considering the blood supply based on the location of the injury

Trauma Surgery: Renal, Bladder, Ureteral, Urethral, and Pregnancy-Related Injuries

• Intraoperative identification of functional contralateral kidney via IVP can impact decision-making in renal trauma
• Left renal vein can be ligated near IVC, while right renal vein lacks adrenal and gonadal vein collaterals
• Nonoperative management is the preferred approach for 95% of renal injuries
• Methylene blue dye can be used to check for leaks during exploration for renal trauma
• Hematuria is a key indicator of bladder trauma, often associated with pelvic fractures
• Cystogram is used to diagnose bladder rupture, with different treatment approaches for extraperitoneal and intraperitoneal ruptures
• Hematuria is unreliable in diagnosing ureteral trauma, requiring multiple imaging tests for accurate diagnosis
• Ureteral injuries may require different approaches based on the location and size of the segment missing
• Urethral trauma is often associated with pelvic fractures and requires a retrograde urethrogram for diagnosis
• Repair of significant urethral tears is delayed for 2-3 months to reduce the risk of complications
• Pregnant trauma patients should be managed with a focus on maternal well-being, estimating pregnancy and monitoring fetal health
• Placental abruption is a serious concern in trauma during pregnancy, requiring close monitoring and potential intervention if indicated