Upper Genitourinary Trauma

Updated: Jan 24, 2017
  • Author: Imad S Dandan, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Overview

Background

Because trauma is a multisystem disease, multiple injuries may be present in the trauma patient. Other injuries often take priority over injuries to the genitourinary (GU) system and may initially interfere or postpone a complete urologic assessment. Coordinated efforts between various services caring for the patient are crucial to ensure comprehensive care, and evaluation of the injured patient with possible GU trauma should not differ from that of other trauma patients. Follow the protocols of the Advanced Trauma Life Support (ATLS) program of the American College of Surgeons to provide total patient care. [1, 2] See the images below.

Ruptured left kidney. Ruptured left kidney.
Contrast-filled urinoma. Contrast-filled urinoma.
Avulsed left renal artery with thrombosis. Avulsed left renal artery with thrombosis.
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Pathophysiology

The kidneys, pelvocaliceal system, and ureters comprise the upper GU tract. The adult kidneys are well protected by the rib cage and vertebral column, but lateral forces can compress them between these structures, leading to injury. Sudden deceleration can cause avulsion injuries to the renal pedicle and pelvocaliceal system.

Only 6% of patients with GU trauma have ureteral injuries, probably due to its small size and mobility, and the protection provided by the psoas muscle posteriorly, the abdominal viscera anteriorly, and the vertebral column medially.

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Epidemiology

From 3 to 10% of patients with multiple trauma have GU involvement; 10 to 15% of trauma patients with abdominal injuries have GU involvement. Renal injuries constitute 45% of all GU injuries; ureteral injuries constitute 6%.

Mortality from upper GU tract injuries is attributed primarily to other associated injuries, and morbidity is 26%. Trauma is the leading cause of death in persons aged 1-40 years and is the third-ranked cause of mortality in all age groups.

According to the National Trauma Data Bank, most renal trauma in children is low grade, is blunt in nature, and occurs in children older than 5 years. Although most pediatric patients are treated conservatively, the rate of nephrectomy has been found to be 3 times higher at adult hospitals than at pediatric centers. Of the injuries, 79% were found to be grade I, II or III, and penetrating injuries accounted for less than 10% of all pediatric renal injuries. [3]

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Patient Education

For patient education resources, see the Kidneys and Urinary System Center, as well as Blood in the Urine.

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