Upper Genitourinary Trauma
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Because trauma is a multisystem disease, multiple injuries may be present in the trauma patient. Other injuries often take priority over injuries to the genitourinary (GU) system and may initially interfere or postpone a complete urologic assessment. Coordinated efforts between various services caring for the patient are crucial to ensure comprehensive care, and evaluation of the injured patient with possible GU trauma should not differ from that of other trauma patients. Follow the protocols of the Advanced Trauma Life Support (ATLS) program of the American College of Surgeons to provide total patient care. [1, 2] See the images below.
The kidneys, pelvocaliceal system, and ureters comprise the upper GU tract. The adult kidneys are well protected by the rib cage and vertebral column, but lateral forces can compress them between these structures, leading to injury. Sudden deceleration can cause avulsion injuries to the renal pedicle and pelvocaliceal system.
Only 6% of patients with GU trauma have ureteral injuries, probably due to its small size and mobility, and the protection provided by the psoas muscle posteriorly, the abdominal viscera anteriorly, and the vertebral column medially.
From 3 to 10% of patients with multiple trauma have GU involvement; 10 to 15% of trauma patients with abdominal injuries have GU involvement. Renal injuries constitute 45% of all GU injuries; ureteral injuries constitute 6%.
Mortality from upper GU tract injuries is attributed primarily to other associated injuries, and morbidity is 26%. Trauma is the leading cause of death in persons aged 1-40 years and is the third-ranked cause of mortality in all age groups.
According to the National Trauma Data Bank, most renal trauma in children is low grade, is blunt in nature, and occurs in children older than 5 years. Although most pediatric patients are treated conservatively, the rate of nephrectomy has been found to be 3 times higher at adult hospitals than at pediatric centers. Of the injuries, 79% were found to be grade I, II or III, and penetrating injuries accounted for less than 10% of all pediatric renal injuries. [3]
For patient education resources, see the Kidneys and Urinary System Center, as well as Blood in the Urine.
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Imad S Dandan, MD Trauma Medical Director, Scripps Memorial Hospital
Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, American Trauma Society, California Medical Association, Society of Critical Care Medicine
Disclosure: Nothing to disclose.
Walid A Farhat, MD, FRCS(C) Associate Professor, Department of Surgery, University of Toronto Faculty of Medicine; Staff Physician, Division of Urology, The Hospital for Sick Children, Canada
Walid A Farhat, MD, FRCS(C) is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, College of Physicians and Surgeons of Ontario, International Pediatric Endosurgery Group
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Eric L Legome, MD Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine
Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians
Disclosure: Nothing to disclose.
David S Howes, MD Professor of Medicine and Pediatrics, Residency Program Director Emeritus, Section of Emergency Medicine, University of Chicago, University of Chicago, The Pritzker School of Medicine
David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Upper Genitourinary Trauma
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