Editing Upper Urinary Tract Trauma (section)

== Answers ==

# Describe the 2018 AAST Kidney Injury Scale
#* Grade I: subcapsular hematoma and/or parenchymal contusion without laceration
#* Grade II: renal parenchymal laceration ≤1 cm depth without urinary extravasation OR perirenal hematoma within Gerota fascia
#* Grade III: renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation OR any injury in the presence of a kidney vascular injury or active bleeding contained within Gerota fascia
#* Grade IV: parenchymal laceration extending into urinary collecting system with urinary extravasation OR renal pelvis laceration and/or complete ureteropelvic disruption OR active bleeding beyond Gerota fascia into the retroperitoneum or peritoneum OR segmental renal vein or artery injury OR segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
#* Grade V: main renal artery or vein laceration or avulsion of hilum OR devascularized kidney with active bleeding OR shattered kidney with loss of identifiable parenchymal renal anatomy
# What are physical exam findings suggestive of renal trauma?
## Flank bruising
## Broken ribs
## Hematuria
# As per the 2020 AUA Guidelines on Urotrauma, what are the indications for imaging in suspected renal trauma?
## Gross hematuria
## Microscopic hematuria and systolic blood pressure < 90mmHG
## Mechanism of injury concerning for renal injury
## Physical exam findings concerning for renal injury
## Penetrating injury
# What is the imaging of choice is suspected renal trauma?
#* CT with IV contrast with immediate and delayed images
# What is the management of renal trauma? With/without urinary extravasation?
#* In hemodynamically stable patients with renal injury, non-invasive management is preferred
#* In hemodynamically unstable patients, immediate intervention (surgery or angioembolization) is required
#* In patients with urinary extravasation due to suspected
#** Parenchymal collecting system injuries, a period of observation without intervention is advocated in stable patients where renal pelvis or proximal ureteral injury is not suspected
#** Renal pelvis or proximal ureteral avulsion (e.g., a large medial urinoma or contrast extravasation on delayed images without distal ureteral contrast), prompt intervention is required
# When is follow-up imaging indicated in renal trauma?
#* AAST Grade IV-V injury, should be done after 48 hours
#* Clinical signs complications (e.g., fever, worsening flank pain, ongoing blood loss, abdominal distention).
# What findings on CTU are suggestive of ureteral injury?
## Contrast extravasation
## Ipsilateral delayed pyelogram
## Ipsilateral hydronephrosis
## Lack of contrast in the ureter distal to the suspected injury
# What is the management of an unstable patient found to have ureteral injury intra-operatively?
#* Ureteral ligation followed by percutaneous nephrostomy tube insertion OR externalized ureteral catheter secured to the proximal end of the ureteral defect with delayed repair of the injury when patient stable
# What is the management of ureteral contusion following gun shot wound?
#* Ureteral stenting OR resection and primary repair depending on ureteral viability and clinical scenario
# What are the surgical options to treat a penetrating ureteral injury following a stab wound?
#* Injury above the iliac vessels: resection of non-viable ureteral tissue followed by uretero-ureterostomy over a ureteral stent; adjunct procedures (psoas hitch, Boari flap) may be needed
#* Below iliac vessels: ureteral reimplantation or uretero-ureterostomy over a stent