5.1 days

MEDICAL: Other Kidney and Urinary Tract Diagnoses, Age > 17 with CC 308

5.4 days

SURGICAL: Minor Bladder Procedures with CC

Urinary tract trauma includes injury to the kidneys, ureters, urinary bladder, and urethra. Although these injuries occur in fewer than 3% of patients admitted to the hospital for trauma, the damage can threaten life and lead to life-long impaired genitourinary (GU) dysfunction. Most urinary tract trauma affects the kidneys (80%). Blunt renal injury is classified as minor, major, and critical trauma. Minor renal trauma occurs when organ tissue is bruised or when superficial lacerations of the renal cortex occur without disruption of the renal capsule. Major renal trauma occurs with major lacerations that extend through the renal cortex, medulla, and renal capsule. Critical renal trauma occurs when the kidney is shattered or when the renal pedicle (stem that contains the renal artery and vein) is injured.

Bladder injury occurs in 8% of GU trauma, usually involves bladder rupture, and can be either intraperitoneal or extraperitoneal. Intraperitoneal bladder rupture occurs with blunt trauma to the lower portion of the abdomen, usually when the bladder is full. The bladder ruptures at the dome (the point of least resistance), and blood and urine collect in the peritoneal cavity. Extraperitoneal bladder rupture usually occurs in conjunction with a pelvic fracture when a sharp bone fragment perforates the bladder at its base. Blood and urine then collect in the space surrounding the bladder base. Urethral injury occurs in 8% of cases of GU tract trauma, whereas ureteral trauma is rare.

Although renal trauma is unusual, it is associated with a 6% to 12% mortality rate, possibly because of the kidneys' high vascularity. Complications of urinary tract trauma include hemorrhage and exsanguination, hypovolemic shock, peritonitis, septic shock, acute renal failure, urinary incontinence, pyelonephritis, and impotence.

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