[Urologic aspects of retroperitoneal hematoma (author's transl)]

Traumatic kidney injuries are the most frequent causes of retroperitoneal hematoma. The intensity of hematuria among other symptoms does not always correspond to the severity of the lesion. Apart from the i.v. urogram as the first screening test, angiography is the most important diagnostic criterion for the estimation of the degree of severity of the injury and in deciding whether or not surgery is necessary. Hemorrhage makes immediate surgery necessary in 10 - 20% of kidney ruptures. In contrast to the combined urohematoma, the simple hematoma is usually absorbed. Secondary complications make drainage or nephrectomy essential. The rupture of the venal vascular peduncle and ruptures of renal arterial aneurysms are seen seldom and are usually fatal. The mortality rate for urohematomas caused by rupture of the bladder/urethra increases, the longer corrective surgery is postponed. Clinically relevant retroperitoneal hematomas after kidney biopsies, operations on the renal parenchyma, and after vascular injuries resulting from angiography are relatively infrequent and require a specific therapy, according to the individual case.