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Difficulty: EasyUrologic Surgery

Match each clinical presentation of genitourinary trauma with the most appropriate immediate diagnostic test or intervention.

  • Pelvic crush injury with blood at the urethral meatus and a palpably elevated prostateRetrograde urethrography
  • Seatbelt trauma to the lower abdomen presenting with gross hematuria, suprapubic tenderness, and an inability to voidRetrograde CT cystography
  • Blunt flank trauma with microscopic hematuria, severe costovertebral angle tenderness, and stable vital signsTriphasic CT scan of the abdomen and pelvis
  • Penetrating flank injury with an expanding retroperitoneal hematoma and persistent hypotension despite fluid resuscitationEmergent exploratory laparotomy

Answer

Pelvic crush injury pairs with retrograde urethrography. Seatbelt trauma pairs with retrograde CT cystography. Blunt flank trauma with stable vitals pairs with a triphasic CT scan. Penetrating trauma with hypotension pairs with emergent exploratory laparotomy.
Each genitourinary trauma presentation requires a specific diagnostic or therapeutic approach based strictly on hemodynamic stability and the anatomic location of the suspected injury. Stable patients receive targeted imaging (urethrography, cystography, or triphasic CT), while unstable patients require immediate surgery.

Step-by-Step Solution

1
Evaluate the patient's hemodynamic status.
Identifies the hypotensive patient with penetrating trauma as requiring immediate surgery rather than imaging.
Hemodynamic instability dictates emergent surgical intervention and overrides the need for preoperative imaging.
2
Assess physical exam findings for localized urologic injuries in stable patients.
Blood at the meatus points to urethral injury, while suprapubic pain following a seatbelt injury points to bladder injury.
Specific physical signs guide the choice of localized contrast imaging and help avoid iatrogenic harm (e.g., placing a Foley catheter in a torn urethra).
3
Match the stable clinical presentations with their respective gold-standard imaging studies.
Assigns retrograde urethrography for suspected urethral injury, cystography for bladder injury, and triphasic CT for renal injury.
Each segment of the genitourinary tract requires a specific radiological technique for accurate evaluation and grading of the trauma.

Key Concept

Initial triage and diagnostic evaluation of genitourinary trauma.
Estimated Time:1m 30s
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Topics

Urologic Surgery

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