Traumatic injuries of the kidney and the urinary tract in blunt abdominal trauma

• Published in: Chirurgie (Heidelberg, Germany) Germany), 2023-08, Vol.94 (8), p.688-695
• Main Authors: Wendler, Johann J, Meyer, F, March, C, Cash, H, Porsch, M, Schostak, M
• Format: Article
• Language: ger
• Subjects: Abdominal Injuries - diagnostic imaging; Abdominal Injuries - therapy; Humans; Kidney - diagnostic imaging; Kidney - injuries; Kidney - surgery; Multiple Trauma - diagnostic imaging; Multiple Trauma - therapy; United States; Urinary Tract - diagnostic imaging; Urinary Tract - injuries; Urinary Tract - surgery; Urology; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy
• ISSN: 2731-698X
• DOI: 10.1007/s00104-023-01906-w

In the context of blunt abdominal trauma, injuries to the urinary tracts often occur, especially in polytrauma patients. Urotrauma is rarely immediately life-threatening but can lead to serious complications and chronic functional limitations during treatment. Therefore early urological involvement is crucial for adequate interdisciplinary treatment. The most important facts for the clinical routine on the consultant urological management of urogenital injuries in blunt abdominal trauma are discussed according to the European "EAU guidelines on Urological Trauma" and the German "S3 guidelines on Polytrauma/Treatment of Severely Injured Patients" as well as the relevant literature. Urinary tract injuries can occur even with an initially inconspicuous status and always require explicit exclusion diagnostics by means of contrast medium tomography of the entire urinary tract and, if necessary, by means of urographic and endoscopic examinations. The most common urological intervention is catheterization of the urinary tract which is often required. Less common is urological surgery, which should be coordinated interdisciplinarily with visceral and trauma surgery. More than 90% of vitally threatening kidney injuries (usually up to the American Association for the Surgery of Trauma (AAST) grades 4-5) are now treated by interventional radiology. Due to possible complex injury patterns in blunt abdominal trauma, these patients should ideally be directed to (certified) trauma centers with subspecialized or maximum care from the departments of visceral and vascular surgery, trauma surgery, interventional radiology and urology.