Upper Genitourinary Trauma

Author: Imad S Dandan, MD; Chief Editor: Rick Kulkarni, MD more...

Updated: Jun 13, 2011

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Background
Pathophysiology
Epidemiology
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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. See the images below.

Ruptured left kidney.

Contrast-filled urinoma.

Avulsed left renal artery with thrombosis.

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.

Frequency

United States

Three to ten percent of patients with multiple trauma have GU involvement; 10-15% of trauma patients with abdominal injuries have GU involvement. Renal injuries constitute 45% of all GU injuries; ureteral injuries constitute 6%.

Mortality/Morbidity

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.

Proceed to Clinical Presentation

Contributor Information and Disclosures

Author

Imad S Dandan, MD Consulting Surgeon, Department of Surgery, Trauma Section, Scripps Memorial Hospital

Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, American Trauma Society, California Medical Association, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Walid A Farhat, MD, FRCS(C) Associate Professor, Department of Surgery, University of Toronto; Staff Physician, Division of Urology, The Hospital for Sick Children

Walid A Farhat, MD, FRCS(C) is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, College of Physicians and Surgeons of Ontario, and International Pediatric Endosurgery Group

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Howes, MD Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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