Trauma Imaging
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain in On Call Radiology, 2015
Bladder injuries may occur when adjacent pelvic injuries are present. Imaging of bladder ruptures can be performed as either direct or indirect cystography. A direct cystogram is obtained by instilling contrast media into the urinary bladder via a urethral catheter and then imaging the patient. This method allows a larger volume of contrast to be instilled under greater pressure, allowing smaller defects to become apparent. An indirect cystogram is obtained by carrying out delayed imaging of the patient following the administration of IV contrast, which is subsequently excreted into the renal collecting systems and bladder. The volume of contrast within the bladder is often less than that seen in direct cystography and is under less pressure. As a result, smaller injuries may be overlooked. In practice, a repeat CT scan at a delayed interval is often easier to perform acutely. Alternatively, fluoroscopic assessment via a cystogram study may be performed. (See Table 5.2.)
Surgical Complications of Kidney and Pancreas Transplantation
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Urine leaks due to breakdown of the duodenal segment may occur years after transplantation, but this complication is usually encountered within the first 2 or 3 postoperative months. The causes of early urine leaks are technical in nature and usually require surgical correction with prolonged Foley catheter drainage. Late leaks (Figure 46.7) can be caused by high pressure in the duodenum during urination. The onset of abdominal pain with elevated serum amylase activity, which can mimic reflux pancreatitis or acute rejection, is a typical presentation. Supporting imaging studies using cystography or CT may be necessary for confirming the diagnosis. Operative intervention may be required and includes reanastomosis to the bladder. Late leaks may develop as the result of rejection and can be treated successfully with Foley catheter drainage.
Complications of Female Incontinence Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Postoperatively, the vagina is packed with an antibiotic-impregnated gauze for several hours. Urethral and suprapubic catheter drainage is recommended until the urine is clear of blood. The urethral catheter may then be removed to minimize mucosal irritation at the site of repair. Oral antibiotics should minimize the risk of infection. Bladder spasms have been postulated to compromise healing of the repair (88), and should be treated. Oral or topical estrogen has been demonstrated to promote healing (89). Cystography is performed at two weeks to document complete healing of the fistula, followed by catheter removal.
The narrow vesicourethral angle measured on postoperative cystography can predict urinary incontinence after robot-assisted laparoscopic radical prostatectomy
Published in Scandinavian Journal of Urology, 2018
Motohiko Sugi, Hidefumi Kinoshita, Takashi Yoshida, Hisanori Taniguchi, Takao Mishima, Kenji Yoshida, Masaaki Yanishi, Yoshihiro Komai, Masato Watanabe, Tadashi Matsuda
Perioperative images may facilitate prediction of urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP). Coakley et al. reported that membranous urethral length determined on magnetic resonance imaging (MRI) was related to the time taken to achieve stable postoperative urinary continence [8]. However, MRI is excessively expensive for use as a routine follow-up survey. In contrast, cystography is a convenient method for evaluating anastomotic leakage in daily practice. Parameters measured on postoperative cystography that are reportedly significantly associated with urinary incontinence after laparoscopic radical prostatectomy or RALP include postoperative shorter membranous urethral length, a more downward-directed bladder neck and a sharper bladder neck angle, a more downward-directed position of the urethrovesical junction (UVJ), hypourethral movement, the narrow posterior vesicourethral angle (PVUA), and the higher ratio between the longitudinal and horizontal length of the bladder (L/H ratio) [9–14].
Is excision necessary in the management of adult urachal remnants?: a 12-year experience at a single institution
Published in Scandinavian Journal of Urology, 2018
Daanesh H. Hassanbhai, Foo Cheong Ng, Li-Tsa Koh
Much of the current literature advocates ultrasound as a first line investigation when urachal anomalies are suspected, with C.T. to be used only when U.S. findings are negative or questionable, due to the increased lifetime radiation-related cancer risk and limited additional information gained [12,13]. However, it is worthy to note that these are made in reference to primarily paediatric populations. In accordance to international guidelines, C.T. is more commonly employed in our institution as part of a work-up for haematuria [14]. Ultrasound is adequately informative for surveillance of urachal lesions due to their extraperitoneal location and relation to the bladder. Cystography magnetic resonance urography and sino/fistulography are also useful in specific cases. In a review by Nogueras-Ocana et al. [15], cystography was performed in all symptomatic cases, yet Little et al. [16] reported little additional information was gained from voiding cystourethrograms and computed tomography. While we propose ultrasonography as a reasonable method to follow-up urachal anomalies deemed benign, we lack evidence of cases where malignant transformation was noted on follow-up. Thus, further long-term follow-up with a larger cohort is needed to demonstrate the superiority of ultrasound in this respect.
Lower urinary tract injuries in patients with pelvic fractures at a level 1 trauma center – an 11-year experience
Published in Scandinavian Journal of Urology, 2023
Lasse Rehné Jensen, Andreas Røder, Emma Possfelt-Møller, Upender Martin Singh, Mikael Aagaard, Allan Evald Nielsen, Lars Bo Svendsen, Luit Penninga
Of 20 patients, 12 (60%) were classified as resolved and sustained no long-term complications. For evaluation of bladder injuries related to pelvic fractures, AUA and EAU recommends cystography (standard AP projection or CT). In case of visible hematuria, cystography is absolute indicated. AUA and EAU guidelines both recommend conservative treatment with CAD in uncomplicated extraperitoneal bladder injuries based on expert opinion [16,19]. Extraperitoneal lesions can be managed with continuous bladder drainage to prevent rise in intravesical pressure which thereby promotes the disruption to heal [30]. Most ruptures heal by 3 weeks, and AUA guidelines recommend surgical repair if healing is not achieved by 4 weeks [19]. As observed in this cohort, patient who are scheduled for open pelvic surgery, any bladder rupture should be surgically repaired to reduce the risk of infection according to guidelines. Surgical repair in intraperitoneal ruptures is always recommended to prevent urine extravasation and consequently peritonitis and abdominal sepsis. In case of complex extraperitoneal bladder injuries, follow-up cystography should be performed to confirm healing, according to AUA and EAU [16,19]. In our cohort, primary treatment of bladder injuries adhered to guidelines. Nevertheless, we observed that no formalized urological follow-up program was scheduled, and 11 (55%) patients had cystography done at different times and indications. Despite inconsistent follow-up strategies, overall severe long-term urinary complications were rare.
Related Knowledge Centers
- Bladder
- Hematuria
- Hydronephrosis
- Urination
- Vesicoureteral Reflux
- Radiology
- Urology
- CT Scan
- Magnetic Resonance Imaging
- Iodinated Contrast