Injury of the urinary system
Summary/Definition
The urinary system includes the kidneys (which resemble the shape of a bean), ureters, bladder and urinary tract, responsible for the production, transportation and excretion of urine from the urinary tract. In addition, it also includes male reproductive organs, for example, testicles, testicular appendage, spermatic cord, vas deferens, scrotum, penis, prostate gland, seminal vesicles, etc. Symptoms and treatment methods vary depending on the organ that has suffered as a result of injury. The most frequently damaged area is the kidneys, and the order of injury frequency is as follows: ureters, bladder, external genitalia.
Symptoms
The most common symptom of kidney damage is hematuria, which is observed in 75-95% of patients. This symptom may be accompanied by abdominal pain, bloating, intestinal obstruction (ileus), nausea and vomiting. In case of severe bleeding, ischemic shock may develop due to significant blood loss. The initial symptoms of ureteral damage are often nonspecific (nausea, abdominal pain and fever) or the course may be asymptomatic at all, which makes diagnosis difficult and may lead to a delay in identifying the problem. After surgery, if the ureters are completely or partially bandaged, symptoms such as high fever (38 °C or higher), pain in the sides and lower abdomen, nausea, vomiting and intestinal obstruction (ileus) may occur. If both ureters are bandaged, this can lead to anuria, which is not accompanied by symptoms at all. Symptoms of bladder damage include difficulty urinating, hematuria, pain in the pelvic area and lower abdomen, as well as soreness with a fracture of the pelvic bones. Increased bleeding due to a fracture of the pelvic bones can lead to ischemic shock. If the urethra is damaged, patients may experience difficulty urinating, urinary retention, and other symptoms. In some cases, bleeding from the external opening of the urethra is possible (95%). Damage to the urethra can also cause the formation of urinary fistulas and urinary incontinence. In case of penile injury, patients may feel sudden pain and a “pop” sensation in the penile area. There is also the development of a hematoma in this area.
Diagnostics
For an accurate diagnosis and proper treatment of urological disorders, as well as to prevent possible complications, it is necessary to conduct radiographic studies in combination with general tests, for example, anamnesis collection, medical examination and laboratory tests of blood and urine. Intravenous pyelography is a research method in which a water-soluble contrast agent is injected into a vein, which is then monitored by X-ray examination for a certain time. Computed tomography is considered the most effective method for diagnosing damage to the urinary system and determining the degree of damage. This method is less invasive compared to venous pyelography and is especially useful for detecting bruises, localization and volume of ruptures, as well as the degree of urine leakage. Ultrasound can be performed with confidence in patients with hypersensitivity to contrast agents, children and pregnant women at risk of radiation, but due to disadvantages such as the inability to assess kidney function, it is mainly used for diagnostic purposes, and not to determine the presence or absence of hematomas around the kidney and other organs in the renal parenchyma, or to track the resorption of hematomas. Reverse urethrography is a method of X-ray examination in which a catheter is inserted through the urethra, and then a contrast agent is gradually introduced to detect damage, blockage, side pockets, cracks, stones, inflammation, tumors, developmental defects and changes in the neck of the bladder. This method is important for assessing the area and extent of damage to the urethra, especially in patients with suspected urethral obstruction.
Treatment and course of the disease
Treatment of urological trauma includes both conservative and surgical methods. Conservative methods of treating kidney damage include hemostasis, shock management, stabilization of the patient’s general condition, antibiotic therapy and SAP therapy. Most cases of severe kidney damage or penetrating trauma require surgical treatment. The damage can heal naturally if there is a small puncture or tear in the ureter, but the leakage of urine is insignificant. In severe cases, surgical treatment is required, for example, ureterocytosis of the urinary tract. Injuries to the bladder caused by a fracture of the pelvic bones initially require emergency care for hemorrhagic shock. In case of an extraperitoneal rupture, treatment is possible only with a permanent urethral catheter for about 10 days. Surgical intervention may be required if large blood clots form in the bladder or if the neck of the bladder is damaged. In case of urethral injury, if normal urination is observed after retrograde urethrography and in the absence of pain and bleeding, additional treatment is not required. If the bleeding continues, a urinary catheter is installed. If the posterior urethra is damaged, cephalocystectomy for catheterization is performed first. After about three months of waiting, the urethra is corrected, when the hematoma in the pelvis resolves and the bladder and prostate return to their original anatomical position. Penile injuries are treated conservatively, including methods to stop bleeding, for example, by squeezing the penis. In addition, surgical treatment is performed, which may include removal of a hematoma, suturing of the alveolar membrane and urethroplasty.
