Practice ABC of Major Trauma, 4th Edition

The Urinary Tract

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1141 (Published 19 March 2014) Cite this as: BMJ 2014;348:bmj.g1141
  1. Jaskarn Rai1,
  2. Ajith Malalasekera1,
  3. Timothy Terry1,
  4. Anthony Deane2
  1. Leicester General Hospital Leicester, UK
  2. William Harvey Hospital Ashford and Buckland Hospital Dover, UK

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Overview

  • Renal trauma is commonly associated with other intra-abdominal injuries, especially in penetrating renal trauma.

  • The imaging method of choice to investigate such patients is contrast-enhanced computed axial tomography (CAT) scan.

  • Most renal injuries can be managed non-operatively, with specific indications for renal exploration.

Upper urinary tract

Ten percent of abdominal trauma leads to renal injury and most of these injuries are mild and can be managed non-operatively. Over the last decade, indications for surgical intervention have been clarified with early use of contrast-enhanced computed axial tomography (CAT) scan imaging. The outcome has been decreased nephrectomy rates using initial conservative management, without any increase in morbidity.

Epidemiology

Renal trauma is an affliction mainly of young men (Box 1), the male-to-female ratio being 3:1. Blunt trauma accounts for over 90% of renal injuries in the UK. Important associated intra-abdominal injuries occur in about 40% of patients with blunt renal trauma. Penetrating injuries cause more renal damage in comparison to blunt trauma and are also more commonly associated with multiorgan involvement (up to 80%).

Box 1

Typical victims of urinary tract trauma

  • Young men while performing sporting activity (55%).

  • People in road traffic accidents (25%).

  • Victims of domestic or industrial accidents (15%).

  • Victims of assault (5%).

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Mechanism of injury

The mechanism of renal injury in blunt trauma can be due to either direct or indirect transmission of forces (Figure 1). In direct trauma the injury results from impact of the lower ribs and anterior abdominal wall with the kidney (e.g. run over injuries). Rapid posterior movement of the kidney can cause a second impact with the lumbar spine and paravertebral …

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