kidney is cushioned by perinephric fat
ureter less vulnerable to blunt trauma
but bladder distended with urine and urethra close priximity to pelvic bones
TTFTT
FTFFT
ureteral or ureteric
genital = penile and scrotal
next slide no need to memorise
Kidney injury (medicAL) vs renal injury (SURGICAL)
Acute onset renal dysfuction is AKI
plytrauma?
have to arranged FAST for any abdominal trauma
provided heamodynamic stable ⇒ Multiphase Contrast enhanced CT...multiphase is different timing
rapid deceleration the pedicle can avulse
left as subcapsular haemotoma
below is shattered left kidney
selective angioembolisation of the bleeder
management no correlation with grade of injury but haemodynalic stability
renorrhaphy by experts
Ureteral trauma
VOG in a TAH easily can damage or sacrifice ureter
female ureter during hysterectomy can easily put clamp
heals by fibrosis
urosepsis
below is from old textbooks and we avoid coz do not want to damage the other ureters
A and B is to bridge the gap if lenght not enough
boari flap is from bladder itelf
dome of the bladder is intraperitoonal
internal means into peritoneal leak or intra
external is leaking outside through drain or vagina
retroperineal urinoma
paralytic ileus
contrast
continous bladder drainage must leave indwelling catheter for two weeks at least until healing
certain part sof urethra are fixed like protastic so discrepancy can cause extravasation and fibrosis can lead to structure
must inject contrast to bladder from penile or suprapubic
apex of prostratic urethral - urethral distraction effects - posterior is distracted and divided
^ second one is only by experts not even general surgeons
urethroplasty is reconstruction of urethra
one good example is bucca mucosal graft
can have LUTS after surgery
Go trhough this as well :
https://www.notion.so/mbbstree/Urology-trauma-b138ee429e1b46c2b86612981a3e0053