The management of penetrating trauma to the urinary tract

Penetrating trauma to the urinary tract is best dealt with early in the overall management of the trauma patient. As there are usually other more obvious associated injuries, involvement of the urinary tract may be overlooked. Delayed management may be of severe consequence to the patient, causing delayed bleeding, retroperitoneal abscess and nephrectomy. Patients suspected for urinary trauma are those with flank or back wounds, retroperitoneal hematoma, pelvic trauma or those presenting with hematuria. The modern approach to trauma emphasizes the staging of injury prior to definite management. Appropriate roentgenographic studies of the urinary tract should be included in the initial evaluation of the patient with trauma. Renal injuries are staged according to severity and method of infliction. Stab wounds or low velocity GSW and those of minor or moderate degree may be managed conservatively with an acceptably good outcome. High velocity GSW usually cause extensive damage and surgical exploration is warranted. Ureteric injuries are rare, but prone to be missed at initial diagnosis. Emergency roentgenologic studies may be insufficient and must be augmented by thorough examination at the initial laparotomy. Hematuria accompanies nearly all instances of bladder trauma. The mandatory investigation is retrograde cystography. The standard approach to penetrating bladder trauma is surgical.