Management of complex violent trauma to the upper urinary tract

Abstract

Since abdominal and retroperitoneal trauma may endanger both the kidney and ureter, urologists are frequently called upon to evaluate an injured patient in the emergency department or in the operating room. In this setting, the suspicion of urological injury begins a clinical cascade of decision making and diagnostic testing. The recognized injury, if appropriately managed, usually heals without incident. The unrecognized injury may jeopardize the recovery of the trauma patient, such as the patient who has sustained an occult ureteral laceration and continues to have an ‘unexplained’ ileus or fever. Although urinary injury is not usually the sole compelling event in severe trauma, thoughtful consideration and treatment of renal and ureteral injuries, collectively referred to as upper urinary tract injuries, will help the surgeon to avoid troublesome management complications. As urological surgeons, we owe a debt to early pioneers in surgical traumatology who provided the groundwork for acute care management and the management of solid and hollow organ injuries. Upon this framework, the management of urological trauma has blossomed through experience and introspection. Advances in imaging modalities, improvements and renovations of surgical technique, and critical review of outcomes data have influenced the management of genito-urinary trauma and will certainly alter the way we treat trauma patients in the next millennium. This paper illustrates some important concepts in acute genito-urinary trauma and helps towards an improved understanding of acute urological care.