Editing Genitourinary tract trauma (section)

== '''Ureter''' ==

* Rare (1% of all genitourinary trauma)
* Aetiology
** Almost always penetrating trauma
** Mostly upper ureter
** Iatrogenic
*** Hysterectomy 0.5%
*** Endourologic procedures 1%
* Diagnosis
** If already in OT - direct inspection, followed by cystoscopy + retrograde pyelogram if necessary
** CT urogram - urinoma, urinary ascites, new hydronephrosis, extravasation of contrast from ureter
*** Complete avulsion - distal ureter will not fill
*** Partial tear - distal ureter will likely fill
*** Haematoma may indicate site of injury
** Fluid sample - check for creatinine
**
* Management
** Doesn't necessarily need to be fixed straight away, especially if multiple other injuries/unstable patient. 
** Need to drain urine somehow - if not draining through ureter, need nephrostomy
** Principles of surgical repair
*** Maintain ureteric blood supply
*** Tension-free anastomosis
*** Debride bleeding edge
*** 4-0 or 5-0 absorbable suture
*** Spatulate ends for primary repair - if the cut ends can be apposed without tension, they should be joined over a double pigtail catheter
*** Damage control - clip ureter proximal to injury and obtain percutaneous drainage
** Exam answers?
*** Primary closure with spatulation
*** Clip proximal end and transfer
**
* Complications
** Stricture - monitor for hydronephrosis with serial USS (to prevent renal disease secondary to asymptomatic obstruction)
** Uroma/infected abscess - treat with drainage and Abx