UROLOGY

(PART I)
KATHLEEN R. GONZALES, MD, FPUA
 @ © @& &s ¢& © 8 «- | B® %
Popout Chat Q8A People Raise React View More Camera Mic

ANATOMY
* Anatomic structures: J)
IS : - Diaphragm
Kidneys 7 I Oveophacue
Left adrenal
Adrenals (suprarenal) gland
Left renal vein

Ureters ? Left kidney

— Abdominal aorta

Bladder —— Inferior vena cava

Prostate " ——
Left ureter

Uterus (female)
Seminal vesicles Left ovary (female}
Urinary bladder
Urethra
—— Prostate (male)

Vas deferens Urethra

Testis Testicle (male)

[S
ituated mainly outside the peritoneum
Kathleen Gonzales MD ll — + B\
 INTRAPERITONEUM AND RETROPERITONEAL ORGANS
and Retroperitoneal Organs - 4

kidneys

Kathleen Gonzales MD | — + Watch on (YouTube

www.anatomuzone.com
 ANATOMY
KIDNEY AND ADRENAL
* Kidneys are paired retroperitoneal organs
invested in a fibro-fatty layer, the Gerota’s
fascia
Bordered by:
Quadratus lumborum — posterolaterally
Psoas muscle — posteromedially
Posterior layer of peritoneum — anteriorly
Spleen — superolaterally (left)
Liver — superolaterally (right)
D2- in close proximity to R renal hilum
 ANATOMY

KIDNEY AND ADRENAL

* Blood supply
* Renal arteries are single vessels from aorta that
branch into several segmental arteries before entering
the renal sinus
* No anastomotic arterial flow so the kidneys are prone » 5 segmental

to infarction when branch vessels are interrupted - Lobar

Interiobar
- Arcuate
* Renal veins which course anterior to the arteries, = Interlobula
— Afferent

drain to the vena cava artenoles

- Glomerular
capdlanies
* These veins provide adequate drainage
 ANATOMY

KIDNEY AND ADRENAL

* Arterial supply of adrenals derives from the
aorta and small branches from the renal
arteries
* Venous drainage on the left — mainly
through inferior phrenic vein and through
the left renal vein via inferior adrenal vein
* Venous drainage on the right — through a
very short vein to the vena cava

Kathleen Gonzales MD
I===—= —=_- —N
 ANATOMY
KIDNEY AND ADRENAL
* The collecting system of the kidney is
composed of several major and minor calyces Right ho Left Kidney
that coalesce to form the renal pelvis renal artery — renal
* Renal pelvis tapers into UPJ where it joins the ry
ureter la —< Wey ~~ o
* Adrenal glands lie superomedially to the | = NA re
kidneys within Gerota’s fascia
* In the presence of a tumor or inflammatory renal veins
process, the adrenal can be very adherent to
 ANATOMY
URETER
® Muscular structures that course anterior to the psoas
muscles from the renal pelvis to the bladder
® Blood supply
* Proximal ureter
— from aorta and renal artery (medial)
* Below the iliac vessels — from iliac arteries (lateral)
* Ureters course along the pelvic side wall and pass
under the uterine arteries in women (water under the
bridge) —prone to injury during hysterectomy
 ANATOMY

BLADDER
* UB situated in the retropubic space in an
extraperitoneal position
* A portion of bladder dome is adjacent to the
peritoneum, so ruptures in this point can result in Urothalium

Lamina propria
intraperitoneal urine leakage
|
FEMALE

* A very distended bladder can project above the

umbilicus
* At physiologic volumes (200-400 mL), projects
modestly into the abdomen
\

Kathleen Gonzales MD
EEE
 ANATOMY

BLADDER
* The sigmoid colon lies superolaterally and
may become adherent or fistulize secondary
to diverticulitis
* Rectum lies posterior to the bladder in males,
vagina and uterus in females

Kathleen Gonzales MD
faa ————— 4%
 ANATOMY
PROSTATE
* Prostate is in continuity with the bladder neck, and the
urethra courses through it
® Significant smooth muscle component and can provide
urinary continence even in the absence of the external
striated sphincter
* Puboprostatic ligament — connect the prostate to the
pubic symphysis so pelvic fractures often result in
proximal urethral injuries
* Denonvillier's fascia — between prostate and rectum,
the main anatomic barrier that prevents prostate cancer
from regularly penetrating the rectum
 ANATOMY
PENIS
* Composed of three main bodies: pair of corpus
cavernosum and corpus spongiosum
® Corpus cavernosum- paired, cylinder-like structures that
are the main erectile bodies of the penis
* Proximally, lie along the medial aspects of the inferior
pubic rami in the perineum
* Distally, they fuse along their medial aspects and form the
pendulous penis
* Consist of a tough outer layer called tunica albuginea
and spongy, sinusoidal tissue inside that fills with blood
during erection
* Have numerous vascular interconnections so they function
as one compartment
N\
Kathleen Gonzales MD a Oo
ECE >
 ANATOMY
PENIS
® Caverosal arteries are branches of the penile artery
® Sinusoidal tissue is innervated by cavernosal nerves
(autonomic nerves from the hypogastric plexus)
* Corpus spongiosum — does not have the same
tunical layers as the corpora cavernosum
® Surrounds the urethra
* Does not exhibit same firmness during erection
® The tip of the penis (glans) is in continuity with the
corpus spongiosum
 ANATOMY

PENIS
Dorsz v
erficial Dorsal
* Surrounding all 3 bodies are the outer dartos Deep Dorsal, Superhicial

fascia and the inner Buck's fascia Wy, - 2. Superficial (Dartos) fascia

* Dorsal nerves of the penis provide sensation I 3 Areolar tissue

V4 4.Deep (Buck's) fascia
to penile skin are derived from pudendal
¢” S5.Tunica albuginea
nerves travel along the dorsum of the penis
Corpus spongiosum
Urethra:

* NVB of the penis must be avoided during

surgical exploration of the penis for injuries or
reconstruction
 ANATOMY
TO

SCROTUM AND TESTES tomprumests |

- =\
* Scrotum — capacious structure that contains the testes
and epididymes beperticasd (Scama's
fuca | Fat lye
| (Camper's
® Layers
* Skin
® Dartos V //
* External spermatic fascia ) J Wi
by Yansversale fascia

* Cremasteric fascia 7
* Internal spermatic fascia \
d \ Meter
® Parietal
i and visceral
i tunica
: :
vaginali si — between which \ J {no
sen
hydrocoeles form Figure 5.7. Contributions of the anterior
abdominal wall to the coverings of the
N Tunica albuginea — outer layer of the testis scrotum, spermatic cord, and testis
Kathleen Gonzales MD
N
 ANATOMY
SCROTUM AND TESTES
* Visceral layer of tunica vaginalis is adherent to the
testis
* Inside the tunica albuginea are the seminiferous
tubules nerve lg —
blood vessels ———— -
spermatic cord

* Blood supply enters the testis at the superior pole vas deferens ——Sui |
by way of spermatic cord seminderous — EE
tubule

* Spermatic cord contains wl. epididymis

Vas deferens Gd
testis — —_

Testicular artery — branch of the aorta

Cresmateric artery
Deferential artery
ampiniform plexus — spermatic veins
ne
 ANATOMY

SCROTUM AND TESTES

* Venous drainage parallels the arterial inflow
* Right gonadal vein — drains to the IVC
* Left gonadal vein — drains to the left renal
vein
* Dilation of spermatic veins is called
varicocoele (can produce pain and
infertility)
 @ BP @ Sw & © 8 - | BW
Pop out Chat Q&A People Raise React View More Camera

UROLOGIC MALIGNANCIES
BLADDER CANCER
* Most common form of bladder cancer in the
US is transitional cell carcinoma (TCC)
* Risk factors: tobacco use, occupational
exposure to carcinogens (automobile exhaust
or industrial solvents)
Other forms of bladder cancer:
* Squamous cell — from chronic irritation from
catheters, bladder stones, schistosomiasis
infection
* Adenocarcinoma — from urachal remnants or
bladder exstrophy
Kathleen Gonzales MD ll — +
 @ PE @& &= & © 8 «- | Bk XX
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC MALIGNANCIES
BLADDER CANCER
® Categorized into invasive(muscle-invasive) and
noninvasive(superficial) Urinary Bladder
Pubic Bone

* TURBT - first step which allows adequate staging

* Tumor is completely resected if possible
* Sampling of muscle layer
* Bimanual examination done under anesthesia is
done to determine fixation to adjacent structures
* Unilateral or bilateral hydronephrosis in CT scan —an
ominous sign of locally advanced disease
CT scan can also provide information on metastatic
Fr olvement of pelvic lymph nodes, liver or lung
Kathleen Gonzales MD lf — | NE (m]
 UROLOGIC MALIGNANCIES
BLADDER CANCER
® Muscle invasive — management is radical
cystectomy with extended lymph node Conduit _ Continent Reservoir
dissection |
Siw x . Fo) vv |) rd
® Addition of neoadjuvant or adjuvant uN Xr AJ | \ ( A pA
chemotherapy MA MT
. - : = Y | i
® Diversion types: continent and noncontinent QO { [|
diversions [=k J} \ J
* Orthotopic neobladder— if without urethral it \ Sorat
involvement; involves detubularization of a wos
segment of bowel (distal ileum) and is then
refashioned into a pouch and anastomosed to
the proximal urethra
\
Kathleen GonzalesMD | — + NG (m]]
 BLADDER CANCER
* |leal conduit — most common noncontinent diversion; a
segment of distal ileum is isolated with one end
brought out through the abdominal wall as a urostomy

* Nonmuscle invasive — managed with TURBT

* Patients at high risk for recurrence and progression
are further treated with intravesical agents such as
BCG and mitomycin C
* BCG acts by induction of an effective immunologic
antitumor response 5

Kathleen Gonzales MD ll — +
 @ © @ Ss mm © a .-- ]
O 4808
Pop out Chat Q&A People Raise React View More Camera

UROLOGIC MALIGNANCIES
BLADDER CANCER
* Approach for cystectomy is a lower midline
incision from the umbilicus to the pubic
symphysis
Ovaries

* Peritoneum and median umbilical ligaments Womb

Cervix
(urachal remnant) are taken with the specimen Bladder

Neo) ( Rectum
* In men, cystoprostatectomy is done
Vagina

* |n women, anterior exenteration is done

(including uterus, ovaries and anterior wall of
vagina)

Kathleen Gonzales MD ll — +
 @ P @ &s & © 8 «- | Bk XX
Pop out Chat Q&A People Raise React View More Camera Mic

RADICAL CYSTECTOMY
\=:¥) Bladder cancer treatment: Cystectomy

From a medical journal > | ”

Watch on (£3 Youlube

Kathleen Gonzales MD
 BLADDER CANCER
® Complications of bladder cancer surgery
involve perforation during TURBT
lleus, bowel obstruction, intestinal
anastomotic leak, urine leak, or rectal injury
during cystectomy and urinary diversion
DVT is common due to advanced age,
proximity of the iliac veins to the resection and
lymph node dissection, and presence of
malignancy

Kathleen Gonzales MD ll — +
 TESTICULAR CANCER
®* Most common solid malignancy in men ages 15 to
35 years of age
Major risk factor is cryptorchidism (undescended
testis)
Most neoplasms arise from the germ
cells(seminanomatous and nonseminomatous)
Nongerm cell tumors (Leydig and Sertoli cell
tumors) are rare and follow a more benign course
All solid testicular masses observed on PE
and documented on ultrasound are malignant
itil proven otherwise
Kathleen Gonzales MD ll — +
 @ A OO Qm ™m © a ]
Pop out Chat Q&A People Raise React View More Camera

UROLOGIC MALIGNANCIES :
TESTICULAR CANCER
* Initial studies must include tumor markers:
* AFP, B-HCG, LDH

®* Chest and abdominal CT to evaluate for metastasis

* Most common site of spread — retroperitoneal lymph

nodes from the common iliac vessels to the renal
vessels

* Retroperitoneal lymph node dissection (RPLND) is

potentially curative in limited lymph node involvement
* No role for percutaneous biopsy due to risk of seeding
Pure seminoma — highly radiosensitive (external beam
A diation)
Kathleen Gonzales MD Ng
NI
 TESTICULAR CANCER
* Orchiectomy is done in an inguinal incision made
over the external ring
Important not to violate the scrotal skin to prevent
altering the lymphatic drainage of testis
For RPLND, a midline incision is made from the
xiphoid process to the the pubic symphysis
Complications of orchiectomy : scrotal hematoma
Complications of RPLND: bowel obstruction,
excessive bleeding (from retrocaval lumbar
a veins), chylous ascit
= N
Kathleen Gonzales MD | — + > (m]
 @ P 2 = & © 8 - | Bk XX
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC MALIGNANCIES
RENAL CANCER Table 40-1 Bosniak Renal Cyst Computed Tomography Classification

®* RCC — malignancy of renal epithelium that ——_ _ per —

can arise from any component of the i , . rr
nephron
Histologic subtypes: clear cell, papillary,
chromophobe, collecting duct, unclasified ———— Beoekn ——
Benign lesions: oncocytomas, \
angiomyolipomas = /
Renal cysts are common Bosniak Ill Bosniak IV

Bosniak classification based on septations, . »

a
 @ P @ &« & © 8 - | BM
Pop out Chat Q&A People Raise React View More Camera

RENAL CANCER
® Most cases are sporadic, but many hereditary forms
have been described
* Von-Hippel-Lindau disease — clear cell RCC
* Birt-Hogg-Dube syndrome — chromophobe tumors

* Most common sites of spread — retroperitoneal lymph

nodes and lungs; liver, bone and brain are also
common sites

Kathleen Gonzales MD ll — +
OJ 01:0031 @ P @ &s & © 8
Pop out Chat Q&A People Raise React View

RENAL CANCER
® Surgical options: partial and radical nephrectomy
(laparoscopic or open)
Laparoscopic partial nephrec is performed only in
experienced hands
Ablative techniques : cryoablation and radiofrequency
— for small renal masses

Kathleen Gonzales MD ll — +
OU 01:01:21

RENAL CANCER
* Up to 10% of RCC invades the lumen of the renal vein
or vena cava

®* Thrombus below the level of the liver — cross-clumping

above and below the thrombus and extraction from a
cavotomy at the insertion of renal vein
* Thrombus above the hepatic veins — bypass technique
(multidisciplinary)

Kathleen Gonzales MD ll — +
 @ 2 @ Sw mm © Ba -- Be pyre
O o10141
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC MALIGNANCIES

RENAL CANCER
® Complications: thrombus embolization to the pulmonary
artery
® Intraoperative transesophageal echocardiography to
monitor possible embolization
® If it occurs, sternotomy/C-P bypass with extraction of
thrombus may be life saving

Kathleen Gonzales MD Ng
 @ 2 @ Sw mm © @& -- ]
O 01:02:51
Pop out Chat Q&A People Raise React View More Camera

UROLOGIC MALIGNANCIES
RENAL CANCER
® Incisions used for nephrectomy:
* Flank incisions — over the 11%" or 12! ribs from the AAL to
the lateral border of the rectus muscle (does not enter the
peritoneum)
® Anterior subcostal — transperitoneal
* Thoracoabdominal — for large tumors esp on the right
where the liver makes the exposure difficult (over the 10"
rib, carried further posterior and anterior than flank
incision)
® Complications: bleeding, pneumothorax, splenic injury,
liver injury, pancreatic tail injury; partial nephrectomy :
jy added risk of delayed bleeding and urine leak

Kathleen GonzalesMD § — + A De
 PROSTATE CANCER
Most common nonskin malignancy in men
Screening include annual DRE and PSA starting at
age 50
Those with African American descent or those with
family history of PCA should be screened starting at
age 45
Men with abnormal DRE or elevated PSA are
indicated to undergo prostate biopsy
Majority of pxs with PCA will not die of the disease by
10 to 15 years

Kathleen Gonzales MD ll — +
0 01:06:41 e PE & &» & © 8 «- | Bk XX
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC MALIGNANCIES
PROSTATE CANCER
®* PCAs graded according to the Gleason Gleason's Pattern
scoring system (a sum of 2 scores) Ros : 1. Seal] unlform
glands

® A primary and secondary score is assigned :

based on the most common and second most |§ 52 Rs bativeen phtnds
2. More stroma

common histologic pattern (1 — most no

differentiated; 5 — least differentiated) > TIA 3. Distinctly
cl ; infiltrative margins

Gleason's scrore 8 to10 or a high PSA level

>20 is much more likely to spread
Most common site of spread — pelvic lymph
nodes and bone
Staging includes bone scan and CT imaging

Kathleen Gonzales MD Sg N
QO 01:07:51 e Pp @& &»s ¢ © &8 - BX ~ Leave
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC MALIGNANCIES
PROSTATE CANCER
* Treatment options: Bladder
hs
* Active surveillance al Sp
® Brachytherapy
* Radical prostatectomy
® External beam radiation
® Androgen deprivation therapy
* Chemotherapy — for metastatic castrate resistant proste

® Complications of radiation therapy: irritative voiding and

bowel symptoms, ED
Complications of prostatectomy: incontinence, ED, urine
\ ak, rectal injury
Kathleen Gonzales MD —~ hg NE (m]
 @ © OO m=» Mm © a -- ]
QO 01:08:49
Pop out Chat Q&A People Raise React View More Camera

UROLOGIC MALIGNANCIES
PROSTATE CANCER
® Surgical approaches for radical prostatectomy
* Retropubic — lower midline incision from pubic
symphysis to approx 5 cm below umblicus;
peritoneum not entered
* Perineal — transverse incision between the
scrotum and anus; reduced blood loss and
faster convalescence but do not allow lymph
node dissection
: i Perineal A h
Robotic — has slowly replaced laparoscopic RetfpUblC Approach el
approach for prostatectomy
* Lymph nodes are removed between the
external iliac and obturator vessels bilaterally
Kathleen Gonzales MD ll — +
 @ = @ Sw mm © a -- Be
O 01:10:09
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC TRAUMA
Grade Injury Type Description

© yma | Subcapsular, withou

* Renal injuries more common during blunt >

trauma (90% of kidney injuries)

* Indications for imaging:
Major deceleration injury
Shock
Gross hematuria
Microscopic hematuria with hypotension
Penetrating injuries to the flank or
abdomen (unless unstable requiring
immediate exploration)

Kathleen Gonzales MD
 @ = OO Lx © © # ] ph
QO or1139
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC TRAUMA

KIDNEY i.—
The American Ass ciation for t f Trauma (AAST) rer yma grading system

® Prime goal — preservation of

renal fun ction I C ree nonenlarging subcapsular perirenal Generally managed conservatively

2 Perinephric hematoma without obvious parenchymal | Generally managed conservatively in a stable patient

* First step — accurately grade comesof the ide

laceration on CT, or a <I cm laceration into the

>I ¢m laceration into the cortex without involvement | Generally managed conservatively in a stable patient

inj u ry of the collecting system

the
+ A deep laceration into the collecting system with Can be observed expectantly in the stable patient, but
B evidence of urinary extravasation on CT, or a may require subsequent urgent or delayed repair. Renal
[ ] aT sca n with \V4 contra st eS segmental renal artery or vein injury with artery embolization may be an option for those who fail
contained hematoma, or partial vessel laceration, conservative therapy.
Id t d d or vessel thrombosis
go S a n a I 5 Renal pedicle injury or multiple deep renal lacerations | Patients often require surgical exploration, but stable patients
(“shattered kidney™) with only parenchymal injury may be safely treated
conservatively.

(CT urogram)

Kathleen Gonzales MD
 @ FE OO Lm & © H Be
QO onr1249
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC TRAUMA
KIDNEY
® To rapidly assess the presence of 2 functional
kidneys and extent of injury, @ single-shot, 10- [rues vee se mene ws re
min IVP (2mL/kg contrast) is used
If IVP is abnormal or the hematoma is pulsatile,
renal exploration should be performed
In renal exploration, begin with controlling the
renal hilum
Complete exposure; all nonviable tissue must
be debrided; injured collecting system must be
repaired; stent or percutaneous drain should be

Kathleen Gonzales MD
 @ FE @ Lm 0 © H Be
QO 01:1409
Pop out Chat Q&A People Raise React View More Camera Mic

Ly

UROLOGIC TRAUMA
URETER
* The retroperitoneal location of the ureter
protects it from external trauma
* Retrograde pyelogram — most sensitive test
for ureteral injury; a stent can be placed if a Dist usarortaroeony :
partial transection is observed MIDDLE i
Direct ureterourelerostomy

* latrogenic or intraoperative injury is common

Transureteroureterostomy

— hysterectomy, LAR, aortic surgery, i.

ureteroscopy
>

Kathleen Gonzales MD ll — + ONE (m’}]

 @ = @ Sw mm © @& Be
OU on1609
Pop out Chat Q&A People Raise React View More Camera Mic

Ls

UROLOGIC TRAUMA

URETER
* Low ureteral injuries (below the iliac vessels)
— ureteral reimplantation
Direct ureteroureterostomy fa)

* Mid-ureteral injuries — uretero-ureterostomy

Transureteroureterostomy |

MIDDLE yo
* For longer defects — Psoas hitch, Boari flap,
Direct ureteroureterostomy
Transureteroureterostomy

Nephropexy Reimplantation
Psoas hitch

* Other techniques — autotranplantation,

transuretero-ureterostomy, ileal ureter

Kathleen Gonzales MD ll — +
 @ FE OO Lm 0 © H Be
QO 011739
Pop out Chat Q&A People Raise React View More Camera Mic

Ly

BLADDER
* Can occur from penetrating and blunt trauma
* Classified into intraperitoneal and
extraperitoneal injuries(more common)
* Injuries are often associated with pelvic
fractures
® Ssx: gross or microscopic hematuria, electrolyte
imbalance, azotemia, metabolic derangements,
leukocytosis (from urine absorption), fever,
~ prolonged ileus

Kathleen Gonzales MD ll — +
OU 01:19:29 @ © OO &n»n 0 © 8

BLADDER
* Diagnostics: fluoroscopic or CT cystogram
(300-400 mL); important to have a postdrainage
film to assess for persistent contrast
* Extraperitoneal injury — catheter drainage for 7
to 10 days (unless surgery is to be done for
pelvic fractures)
* Intraperitoneal injury — explored immediately
and repaired
“| © All should have cystogram prior to catheter
Jy. removal
Kathleen GonzalesMD | — + L NE) (=)
 @ = @ wm mm © a -- ]
O 01:2623
Pop out Chat Q&A People Raise React View More Camera

UROLOGIC TRAUMA
URETHRA
® Divided into anterior location (penile and bulbar) and
posterior (membranous and prostatic)
® Should be anticipated with pubic ramus fractures and
occur in 10% of unilateral and 20% of bilateral injuries
® Any patient with blunt pelvic trauma, blood per meatus,
hematuria, inability to void, perineal hematoma (should
consider urethral injury until proven otherwise)
* Diagnostics: Retrograde Urethrography (RUG)
® Partial or complete disruption can be diagnosed based
on extravasation or filling of the proximal urethra
\
Kathleen Gonzales MD Ng A
O o01:2738 @ © OO Sw 0 © 8
Pop out Chat Q&A People Raise React View More

URETHRA
Partial urethral injuries — attempt at catheter
placement
Complete disruption — placement of suprapubic
tube, primary repair
Anterior injuries — related to blunt straddle
injuries and penetrating trauma
Management: catheter drainage; primary repair
for 1-2cm defect
Posterior injuries — from pelvic crush injuries
and shearing forces
Management: suprapubic tube, delayed repair
\ or delayed primary realignment *
Kathleen Gonzales MD ll — +
OU 012829

URETHRA
Urethral strictures — trauma or
inflammatory process
Staged by either RUG or VCUG
Type of repair depends on location, length,
severity
Short defects — dilatation or cystoscopic
urethrotomy
Long defects — open repair, grafting”

Kathleen Gonzales MD — ig
 @ FE @ Sw ®m © B&B Be
O 01:2859
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC TRAUMA
TESTES
®* Most commonly occurs with blunt injuries
with enough force to rupture the tunica
albuginea
* Ultrasound is the preferred imaging — to
evaluate testicular blood flow, presence of
testicular contusions, intratesticular aT ne:

hematoma, hematocoele or disrupted tunica Testicular rupture, before and after surgical debridement and
repair.

albuginea

Kathleen Gonzales MD
 @ E @ Lm 0 © H ]
QO 01:29:49
Pop out Chat Q&A People Raise React View More Camera

UROLOGIC TRAUMA
TESTES
* Goal of surgery: salvage as much
parenchyma as possible; and avoid
Ischemic atrophy (from a large hematocele)
or abscess formation
® Aruptured tunica albuginea can be repaired
primarily and nonviable tissue debrided
* With major devascularization and nonviable Testicular rupture, before and after surgical debridement and
repair.

tissues, orchiectomy may be required

Kathleen Gonzales MD ag
 @ = OO Q= ™m © & a Be
OU 01:30:59
Pop out Chat Q&A People Raise React View More Camera Mic

UROLOGIC TRAUMA
PENIS
* Rare injuries that involve a traumatic rupture of the
tunica albuginea (usually during sexual intercourse)
* The engorged penile corporeal bodies can rupture if
sufficient force is generated against the partner’s
pubic symphysis or perineum
* May notice an immediate audible “pop” and
experience rapid detumescence; immediate swelling
* If Buck's fascia is disrupted, swelling and ecchymosis
throughoutthe perinuem (butterfly sign)

=
Kathleen Gonzales MD — ag NS =
OU 01:31:29

PENIS
® Exploration by a circumcising incision and repair
of the defect offers the best chance to avoid
permanent ED and penile deformity
RUG to rule out urethral injury

Kathleen Gonzales MD “= ing

 @ = OO Q= ™m © & a ] ph
Pop out Chat People Raise React View More Camera Mic

Urology | = Last Modified: 16 November v pol Search Kathleen Gonzales KG

File Home Insert Draw Design Transitions Animations Slide Show Record Review View Help = | | ® Record | 5 Share ~

1 Bou BD Prd | § ai
[Reset (1) Replace ~
New = B Shapes Arrange = Dictate | Add-ins | Designer
Slide ~ [J Section ~ - ~ Is Select ~ =
Clipboard Slides Font Paragraph Difeeng Editing Voice Add-ins ~

~ THANK YOU
Ly

KATHLEEN GONZALES, MD, FPUA

THANK YOU
[EP ———— vy

¥
=

Slide 52 of 52 English (United States) J Accessibility: Investigate == Notes = EE HB p+ 7% QO <

Kathicen Gonzales MD [i | + [ESRSuae pw i Ww @ na e es G & AE zES BW) MG nmi =

oc