Trauma and Reconstructive Urology
What this domain tests
This domain tests urethral stricture, urinary diversion, and genitourinary trauma, including injury grading and when to operate versus observe.
Core rules and concepts
- Urethral stricture evaluation includes history, uroflow, retrograde urethrogram, and cystoscopy. Short bulbar strictures may be treated with dilation or internal urethrotomy; longer or recurrent strictures often need excision and buccal mucosa graft urethroplasty.
- Urinary diversion includes ileal conduit and orthotopic neobladder. Patient selection, renal function, manual dexterity, and motivation determine the choice. Metabolic consequences include hyperchloremic acidosis and vitamin B12 deficiency after long ileal segments.
- Renal trauma is graded by CT findings. Hemodynamically stable patients with grade I–IV injuries usually receive nonoperative management; grade V or instability may require angiography or surgery.
- Suspected urethral injury in a trauma patient with blood at the meatus or high-riding prostate contraindicates blind catheterization; perform retrograde urethrogram.
- Testicular rupture requires scrotal exploration; blunt bladder injury may need repair.
Worked example
A 40-year-old man has a 2-cm bulbar stricture after failed repeated dilation. Reasoning: retrograde urethrogram defines length and location. A buccal mucosa graft urethroplasty offers better durable success than another dilation, especially for recurrent stricture.
Traps
Do not place a urethral catheter when urethral injury is suspected. Do not operate on every stable renal injury. Do not choose neobladder without assessing cognition and motivation.