In patients with renal trauma, immediate surgical exploration is required in which of the following scenarios?
Answer E
Immediate surgical exploration is only required in patients with haemodynamic instability despite adequate resuscitation. Blood products can be used in the resuscitation phase and allow successful conservative management or angioembolisation. Grade 4 renal trauma should be managed without surgical intervention in the majority of cases. Bilateral injuries are a good indication for ultraconservative management, as the likelihood of nephrectomy increases dramatically with surgical intervention.
Which of the following principles are accepted standard practice in ureteric reconstruction after trauma?
Basic principles include all of these options as well as an internal ureteric stent and external drain.
Which of the following is a strong indication for the surgical exploration of bladder trauma?
Answer A
Flame like contrast extravasation suggests an extraperitoneal injury which can be managed conservatively. There is however, increasing data to support early surgical repair of extraperitoneal bladder injuries if internal fixation is performed. Catheter difficulties following bladder trauma are best managed by operative intervention and bladder repair.
In urethral trauma secondary to pelvic fracture, which of the following procedures is not used in the acute management?
Answer B
Antegrade urethrogram is useful in the planning of delayed reconstruction but is difficult and not helpful in the acute phase of management. Flexible urethroscopy can be used to assess the injury and catheterise the bladder per urethra.
Suspected testicular rupture is best managed by:
Urgent exploration should follow and will result in higher rates of testicular salvage.
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