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Imaging of Penetrating Urologic Trauma

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Penetrating Trauma

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Abstract

Penetrating injury to the abdomen causes ureteral injury in approximately 2%, kidney injury in up to 8%, and injury to the bladder in up to 20%. Microscopic or gross hematuria are unreliable as a diagnostic tool for any urological injury, and hematuria may be even absent in cases of complete transection of one ureter. Significant penetrating injuries to the major collecting system may present without hematuria because urine from the injured kidney exits into the retroperitoneum, preventing ureteral conduction. About half of the patients with injuries to the urinary tract are hypotensive on presentation, indicating the overall severity of trauma and not the urologic injury itself. These patients require immediate laparotomy without delay. Additionally, nearly all gunshot injuries with involvement of the urinary tract are associated with significant concomitant injuries. The decision making regarding diagnostic procedures and treatment of penetrating urologic trauma clearly depends on the hemodynamic status and associated injuries of the patients. As soon as the patient is stable, an evaluation of the urinary tract should follow as part of the secondary survey. The vast majority of urologic injuries are not life threatening. However, failure of diagnosis and delay in treatment may lead to significant patient morbidity due to systemic intra- or extra-peritoneal infection.

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Authors and Affiliations

  1. Division of Trauma and Critical Care, Department of Surgery, Naval Trauma Training Center, Los Angeles County General Hospital (LAC + USC), University of Southern California, 1200 North State Street, IPT, C5L100, Los Angeles, CA, 90033 – 4525, USA

    Beat Schnüriger

  2. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Beat Schnüriger

  3. Division of Trauma & Surgical Critical Care, Naval Trauma Training Center, LAC + USC Medical Center, Room 6341 1200N State Street, Los Angeles, CA, 90033, USA

    Donald J. Green

Authors
  1. Beat Schnüriger
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  2. Donald J. Green
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Corresponding author

Correspondence to Beat Schnüriger .

Editor information

Editors and Affiliations

  1. Dept. Surgery, Massachusetts General Hospital, Fruit Street 55, Boston, 02114, Massachusetts, USA

    George C. Velmahos

  2. Medical School, Dept. Surgery, University of Witwatersrand, York Road 7, Johannesburg, 2193, South Africa

    Elias Degiannis

  3. Klinik für Viszeral-, Thorax- und, Gefäßchirurgie, Univ.Klinikum Marburg, Baldingerstraße, Marburg, 35043, Germany

    Dietrich Doll

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© 2012 Springer Berlin Heidelberg

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Schnüriger, B., Green, D.J. (2012). Imaging of Penetrating Urologic Trauma. In: Velmahos, G., Degiannis, E., Doll, D. (eds) Penetrating Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-20453-1_18

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  • DOI: https://doi.org/10.1007/978-3-642-20453-1_18

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-20452-4

  • Online ISBN: 978-3-642-20453-1

  • eBook Packages: MedicineMedicine (R0)

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