Kidney and ureter trauma

From greek.doctor

Kidney trauma

  • Epidemiology
    • Kidney injury occurs in 1 – 5% of all trauma
    • Kidney injury is the most common genitourinary injury
  • Etiology
  • 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