Kidney and ureter trauma

Kidney trauma

• Epidemiology
  • Kidney injury occurs in 1 – 5% of all trauma
  • Kidney injury is the most common genitourinary injury
• Etiology
  • Blunt trauma to abdomen
  • Penetrating wounds of abdomen
  • Motor vehicle accidents
• Suspicious features
  • Haematuria
  • Pain
  • Bruising
  • Haematoma
  • Fracture of lower ribs
• Evaluation
  • Contrast CT
    • To grade kidney damage
• Grading of kidney trauma
  • Grade I
    • Subcapsular haematoma without laceration
  • Grade II
    • Perirenal haematoma
    • Laceration into kidney parenchyme < 1 cm deep
  • Grade III
    • Laceration into kidney parenchyme > 1 cm deep
  • Grade IV
    • Laceration involving the collecting system
    • Renal artery or vein injury
  • Grade V
    • Shattered kidney
    • Renal artery or vein avulsion
• Management
  • Kidney trauma is mainly managed nonoperatively
    • Patients are kept on bed rest until the urine is grossly normal (no haematuria)
  • Grade I – III kidney trauma -> monitoring
  • Grade IV – V kidney trauma
    • Haemodynamically stable -> monitoring
    • Haemodynamically unstable -> open surgery

Ureteral trauma

• Most ureteral injuries are iatrogenic, due to procedures
• External trauma is rare
  • Sometimes seen in penetrating trauma and motor vehicle accidents
  • Other abdominal injuries are often present
• Suspicious features
  • Haematuria
  • Flank pain
  • Fever
• Diagnosis
  • CT
• Treatment
  • DJ stent placement or nephrostomy
  • Afterwards, any surgical repair may be performed