By Brew S., D. Cranston, J. Noble
This identify integrates uncomplicated technology with scientific perform and likewise revised case experiences to assist readers to take a problem-based method remedy. Urology presents the easy yet authoritative advice clinical scholars have to get them in the course of the urology sections in their education. all through, evidence-based perform is highlighted to make sure the publication can also be a priceless reference for certified employees.
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Additional resources for Urology: A Handbook for Medical Students
Penetrating (externally penetrating) bladder injuries are unusual in the UK, but obviously a penetrating wound in the lower abdomen should alert you to the possibility that the bladder may have been injured. Spontaneous rupture of the bladder can occur in patients who have undergone previous bladder augmentation (where a segment of detubularized bowel is stitched onto the dome of the bladder in order to increase its capacity). The patient with a bladder injury will usually complain of lower abdominal or suprapubic pain (though patients with neurological disorders such as spina bifida or spinal cord injuries—some of whom may have had a bladder augmentation— 38 UROLOGY: A HANDBOOK FOR MEDICAL STUDENTS Fig.
In such a situation how can one adequately visualize the bladder? A suprapubic catheter should be placed either percutaneously, or (more commonly) by formal open cystostomy, through a short transverse lower abdominal incision with direct visualization and catheterization of the bladder. If a percutaneous suprapubic catheter has been placed then a cystogram can be obtained via this catheter. If an open cystostomy is done then the inside of the bladder can be directly inspected at the time of the procedure.
Penetrating trauma is the commonest mechanism of injury. In the UK, where gunshot wounds are rare, most cases of ‘penetrating’ ureteric injury are related either to pelvic surgery (colorectal or gynaecological) or occur during ureteroscopy. The ureter is vulnerable to injury during pelvic surgery because of its intimate relationship with the broad ligament and uterine artery in women (hence it may be injured during hysterectomy) and the rectosigmoid colon and mesocolon in both sexes. Blunt ureteric trauma is rare.
Urology: A Handbook for Medical Students by Brew S., D. Cranston, J. Noble