Types of injuries
- Closed (blunt) injury - blow, fall, compression; accounts for the majority of cases
- Open (penetrating) trauma - knife and gunshot wounds
- Iatrogenic trauma - damage during operations on the abdominal and pelvic organs, during endoscopic interventions, catheterization
- Kidney injury: from bruise and small hematoma to rupture with damage to the vascular pedicle
- Trauma to the ureter - often iatrogenic, during gynecological and coloproctological operations
- Bladder injury: extraperitoneal rupture due to a pelvic fracture and intraperitoneal rupture due to a blow to a full bladder
- Trauma to the urethra - typical for pelvic fractures in men
Symptoms
- Blood in urine - from microscopic to massive with clots
- Pain in the lumbar region, side, lower abdomen
- Bruising and swelling in the lumbar region
- Growing formation in the side - retroperitoneal hematoma
- Inability to urinate when urge
- Blood at the external opening of the urethra
- Hematoma of the perineum and scrotum of a characteristic shape
- Tension of the abdominal muscles, signs of peritoneal irritation due to intraperitoneal rupture of the bladder
- Decreased blood pressure, rapid pulse, pallor with significant blood loss
- The absence of blood in the urine does not exclude serious injury - if the ureter or vascular pedicle is completely torn off, the urine may be clear
Важное правило: при подозрении на разрыв уретры — кровь у наружного отверстия, гематома промежности, перелом таза — категорически нельзя устанавливать уретральный катетер. Это превращает частичный разрыв в полный. Мочу выводят через цистостому.
Diagnostics
- CT of the abdomen and pelvis with intravenous contrast and delayed phase is the main method; determines the degree of kidney damage, the presence of urine leakage and active bleeding
- Ultrasound is a quick method at the initial assessment stage, detects free fluid
- General urine test, including microhematuria
- Complete blood count, hemoglobin monitoring over time
- Retrograde urethrography is mandatory if urethral rupture is suspected
- Cystography with tight filling - if a bladder rupture is suspected
- Excretory urography when CT is unavailable
- Angiography - with ongoing bleeding, with the possibility of embolization
Treatment
The modern approach is as conservative as possible: most closed renal injuries are successfully treated without surgery if the patient is in a stable condition.
- Bed rest, observation, control of hemoglobin and urine - for mild to moderate kidney damage
- Infusion therapy, pain relief, antibacterial prophylaxis
- Angiographic embolization of a bleeding vessel - allows you to stop bleeding without surgery and save the kidney
- Ureteral stenting or percutaneous nephrostomy - for urine leakage
- Cystostomy - for rupture of the urethra and impossibility of catheterization
- Suturing a bladder rupture with intraperitoneal injury; extraperitoneal lacerations often heal with a catheter
- Reconstruction of the ureter in case of damage
- Delayed urethroplasty after urethral rupture - usually several months later
- Surgery and, if it is impossible to save the organ, nephrectomy - in case of unstable condition, ongoing bleeding and destruction of the kidney
Long-term consequences and follow-up
- Urethral stricture is a typical consequence of urethral rupture; requires reconstructive surgery
- Ureteral stricture after injury
- Arterial hypertension after kidney injury - may develop months later
- Formation of urinary leakage and urinoma
- Decreased function of the damaged kidney
- Control ultrasound and assessment of renal function at the appointed time
- Long-term blood pressure control
- Uroflowmetry after urethral trauma
Повышение артериального давления через месяцы после травмы почки — известное и нередко пропускаемое последствие. Поэтому после серьёзной травмы почки давление стоит контролировать регулярно, даже при полном благополучии.
Prevention and what is important to know
- Use of seat belts and protective equipment in sports
- Particular caution with a single, horseshoe-shaped or dystopic kidney - they are less protected
- People with known kidney abnormalities and large cysts should avoid contact sports
- After any injury to the lower back with blood in the urine, a mandatory examination is required, even if you feel well
- Inform the doctor about the kidney injury during subsequent examinations: changes in the images may be a consequence of it
Where to contact in Tashkent
In case of urinary tract injury, round-the-clock CT scanning, hospitalization, and the possibility of angiographic embolization, drainage, and emergency surgery are needed.
In Tashkent, such assistance, as well as delayed reconstructive operations for the consequences of injuries - urethroplasty and ureter restoration - are performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you notice blood in your urine after a blow to the lower back or a fall, consult a doctor the same day, even if the pain is moderate and you feel well. Clinic contacts are below on the page.
