Urinary Tract Trauma

Abstract

For every 100 cases of renal contusion there will be a further 7 with renal laceration, 3 with a ruptured kidney, and 3 with a renal vascular pedicle injury, so the chances of any one surgeon seeing very many of these is quite small (Fig. 8.1). The kidney is the commonest single organ that is damaged and is more commonly injured than the spleen. Following in decreasing order of frequency are injuries to the kidney and spleen together, the liver on its own, the liver and spleen and a combination of kidney and liver. Thus, renal injuries in isolation are common. The injury is usually a contusion in which the renal capsule remains intact so there is very little in the way of long-term problems. If there is laceration of the kidney the capsule is usually torn and there is extravasation of blood and sometimes of urine. Complete rupture of the kidney in which there is total disruption of the renal capsule, often with areas of dead kidney, is again a rare lesion. I have only ever seen one pedicle injury. A further, even rarer, type of injury is disruption of the pelvi-ureteric junction unassociated with any other injury. I have never seen such a case.