TY - CHAP M1 - Book, Section TI - Genitourinary Tract A1 - Kim, Fernando J. A1 - da Silva, Rodrigo Donalisio A2 - Feliciano, David V. A2 - Mattox, Kenneth L. A2 - Moore, Ernest E. PY - 2020 T2 - Trauma, 9e AB - KEY POINTSAbout 25% of kidneys receive accessory arterial branches directly from the aorta.Approximately 90% of significant renal injuries are due to blunt trauma in the United States.Injuries to the renal pedicle, including intimal disruption of the renal artery or renal devascularization, present with no hematuria in 20% to 33% of patients.Advantages of computed tomography (CT) over intravenous pyelogram (IVP) include identification of contusion and subcapsular hematoma, definition of the location and depth of parenchymal lacerations, more reliable demonstration of the extravasation of contrast, and identification of injuries to the pedicle and artery.Although hematuria is an important sign of ureteral injury, it may be absent 15% to 45% of the time.Indications for renal exploration include hemodynamic instability or ongoing hemorrhage presumably related to the kidney, pulsatile or expanding perirenal hematoma at laparotomy, and avulsion of the pedicle.Partial nephrectomy for polar lesions is performed using a “guillotine” technique with the transected vessels ligated and the collecting system closed.Ninety percent of grade V renal injuries require urgent nephrectomy.Delayed recognition of an injury to the ureter is managed with endoscopic or interventional radiology techniques due to local inflammation, edema, friability, and presence of a urinoma.Nonoperative management of an extraperitoneal injury to the bladder is with an indwelling catheter for 10 to 14 days followed by a cystogram. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1175139141 ER -