Upper Genitourinary (Kidney, Ureter) Trauma Clinical Presentation

Updated: Jan 10, 2023
  • Author: Sunny Mei-Chun Wang, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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In blunt trauma, history should include the time and mechanism of injury, the position of the patient, the speed of the vehicle (if a vehicle is involved), and the use of restraints.

In penetrating trauma, knowing the size of the stabbing weapon or the caliber of the gun and the distance from which it was discharged aids assessment.

Paramedics should be questioned as to the condition of the patient immediately after injury occurred and during transport to the hospital.

In patients with GU trauma, symptoms are nonspecific and may be masked by or attributed to other injuries.

Renal injuries most commonly result from motor vehicle accidents (MVAs). Renal injuries occur in 3% of patients hospitalized with trauma and in 10% of those with abdominal trauma. Most renal injuries (80%) are minor and do not require surgical intervention.

Renal injury should be suspected when fractures of lower ribs and/or spinal processes are observed and/or when a history of sudden deceleration or significant lateral force on the patient exists. In penetrating trauma, the trajectory of the bullet or the penetrating object may reveal the possibility of renal injury.

Iatrogenic ureteral injuries are much more frequent than violent ones. A high incidence of associated organ injuries with ureteral injuries exists (90% in gunshot wounds, 60% in stabbings). Diagnosis of ureteral injury depends mainly on clinical suspicion. History and physical examination are unreliable and often are not sensitive.

Iatrogenic injury to the ureter can be a devastating complication of modern surgery. Most often, such injuries to the ureters occur during gynecologic, colorectal, or vascular pelvic surgery. [13]



The most common cause of renal injury is blunt trauma, followed by penetrating trauma. [1] Motor vehicle accidents and gunshot wounds account for 80% of renal injuries. Conversely, the etiology of ureteral trauma is most often iatrogenic (82%). In noniatrogenic cases of ureteral injury, penetrating trauma accounts for 90% (missile injury in 90%, stabbing injury in 10%), with a blunt avulsing-type mechanism causing the remaining 10% of injuries.

Blunt trauma includes the following:

  • MVAs

  • Motorcycle accidents

  • Falls from high elevations

  • Bicycle accidents

  • Assaults with blunt weapons

Penetrating trauma includes the following:

  • Missile injuries: One should differentiate between low- and high-velocity missiles.

  • Shotgun wounds: Close-range injuries are equivalent to high-velocity injuries.

  • Stabbings

  • Impalements

Iatrogenic trauma is also reported.