History

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]

Causes

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.

Differential Diagnoses

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Media Gallery

Ruptured left kidney.
Avulsed left renal artery with thrombosis.
CT scan of abdomen and pelvis showing a urinoma.
Urinoma by CT.
Lateral view of a urinoma.
Contrast-filled urinoma.
Retrograde urethrogram showing a leak in the distal right ureter with an element of obstruction.

of 7

Author

Sunny Mei-Chun Wang, MD, FACEP Assistant Residency Director, Bon Secour Mercy Health - Mercy Anderson; Emergency Physician, US Acute Care Solutions (USACS)

Sunny Mei-Chun Wang, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Kristine Song, MD ER Attending Physician, US Acute Care Solutions (USACS North); Emergency Medicine Residency Core Faculty, Simulations Director, Transitional Year Residency Program Director, Mercy Health — Anderson Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai

Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

David S Howes, MD Professor of Medicine and Pediatrics, Residency Program Director Emeritus, Section of Emergency Medicine, University of Chicago, University of Chicago, 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Imad S Dandan, MD Trauma Medical Director, 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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Walid A Farhat, MD, FRCS(C), FACS, GPLLM Professor and Chief of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health

Walid A Farhat, MD, FRCS(C), FACS, GPLLM is a member of the following medical societies: American Academy of Pediatrics, American Association of Pediatric Urologists, American College of Surgeons, American Urological Association, Canadian Urological Association, Societies for Pediatric Urology, Society for Fetal Urology

Disclosure: Nothing to disclose.