Surgery>>>>>Trauma
Question 28#

Which of the following statements is FALSE regarding traumatic genitourinary injury? 

A. If exploratory laparotomy is performed for trauma, all blunt and penetrating wounds to the kidneys should be explored
B. Renal vascular injuries are common after penetrating trauma, and can be deceptively tamponaded by surrounding fascia
C. Success of renal artery repair after blunt trauma is slim, but can be attempted if injury occurred within 5 hours or patient does not have any reserve renal function (solitary kidney or bilateral injury)
D. Suspected ureteral injuries in patients with penetrating trauma or pelvic fractures can be evaluated intraoperatively with methylene blue or indigo carmine administered intravenously
E. Bladder injuries with extraperitoneal extravasation can be managed with Foley decompression for 2 weeks

Correct Answer is A

Comment:

When undergoing laparotomy for trauma, the best policy is to explore all penetrating wounds to the kidneys. However, over 90% of blunt injuries are treated nonoperatively; the indications for surgery include parenchymal injuries leading to hypotension and evidence of renovascular injury. If laparotomy is performed in the setting of blunt kidney injury for other reasons, expanding or pulsatile perinephric hematomas should be explored. Injuries to the ureters are uncommon but may occur in patients with pelvic fractures and penetrating trauma. An injury may not be identified until a complication (ie, a urinoma) becomes apparent. If an injury is suspected during operative exploration but is not clearly identified, methylene blue or indigo carmine is administered IV with observation for extravasation. Bladder injuries are subdivided into those with intraperitoneal extravasation and those with extraperitoneal extravasation. Extraperitoneal ruptures are treated nonoperatively with bladder decompression for 2 weeks, whereas injuries with intraperitoneal extravasation can be closed primarily. Urethral injuries are managed by bridging the defect with a Foley catheter, with or without direct suture repair. Strictures are not uncommon but can be managed electively.