Education And Debate

ABC of Urology: UROLOGICAL TRAUMA AND BLADDER RECONSTRUCTION

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7042.1352 (Published 25 May 1996) Cite this as: BMJ 1996;312:1352
  1. Chris Dawson,
  2. Hugh Whitfield

    Trauma Renal trauma

    Ten per cent of patients with blunt or penetrating injuries of the abdomen have associated renal trauma. Evaluation begins with a history of the mechanism of the injury, which is important for predicting the likely complications. Investigations of likely renal injury must go hand in hand with the investigation of other likely injuries, and vigilance should be maintained at all times.

    Investigating patients with suspected renal trauma

    • Condition

    • Hypotensive patients needing immediate surgery

    • Hypotensive patients with microscopic haematuria

    • Normotensive patients with macroscopic haematuria

    • All children with haematuria

    • Investigation

    • Single shot intravenous urography

    • Computed tomography (or urography if not available)

    Patients admitted with severe abdominal injury and shock will need immediate laparotomy. In these patients one shot intravenous urography should be performed in theatre to confirm that both kidneys are functioning. Patients found to have either frank haematuria or microscopic haematuria and clinical shock should ideally be investigated with contrast enhanced computed tomography, which is better than urography in patients with suspected renal trauma. In patients with blunt trauma and microscopic haematuria but normal blood pressure, the incidence of important injury is small, and imaging is not needed. If microscopic haematuria persists for more than six weeks then intravenous urography and cystoscopy should be performed to exclude a coincidental tumour.

    Angiograms showing renal trauma before embolisation (top) and after embolisation (bottom).

    A different approach is needed in children, in whom no correlation between degree of haematuria and severity of injury has been found. Some studies have stated that all children presenting after trauma with haematuria (whether microscopic or macroscopic) should be investigated with computed tomography as the likelihood of important renal injury is greater …

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