Injuries of the urinary system( kidneys, bladder, urethra)

Injuries to the organs of the urinary system are damage to these organs caused by the action of mechanical force from the external environment. Depending on the affected organ, they are divided into kidney trauma, bladder trauma and ureteral injury .Damage to other organs is not considered in view of their rare occurrence.

Causes of Traumatic Damage to the Urinary System

The most common cause injury to the kidneys of the is a blunt attack in the lumbar region. Most often this happens when a person falls on his back with a snowboard, skateboard or bicycle. In addition, such kidney damage is often diagnosed after street fights.

The cause of bladder injury , as a rule, is a blow to the suprapubic zone. In most cases, organ rupture occurs only when the latter is full of urine. The application of the same blow on an empty bladder can threaten only submucosal hematoma, which within a few weeks dissolves without any consequences.

A fairly specific trauma to the genitourinary system is the

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urethral rupture of the .Its cause, most often, is a fall onto a bicycle frame or an open sewer.

In addition to blunt or closed injuries of the urogenital system, there are also open ones. Their cause may be a chipped, cut, torn or gunshot wound. In wartime, trauma to the organs of the genitourinary system, in most cases, was due to mine ruptures. Most often these were penetrating wounds of the bladder and urethra, where fragments of mines fell.

Symptoms of Traumatic Damage to the Urinary System

The main symptoms of the blunt trauma of the kidney are pain in the lower back, urination and the appearance of blood in the urine. Pain, as a rule, is acute and localized on the side where the impact occurred. It increases with physical activity and during the act of urination. Some patients in this area have a different hematoma and shape. Violation of urination with a bruised kidney can be accompanied by a decrease in the amount of urine and frequent reflex urges, which in some cases may even be imperative, that is, without the excretion of urine. Hematuria or the presence of blood in the urine can fluctuate from a slight sediment to whole bunches, which can be a sign of profuse bleeding.

Hemorrhage in the retroperitoneal space

Quite often, renal arterial hypertension develops in the kidney trauma, which has a malignant character and very poorly yields to drug treatment.

Bladder rupture of is accompanied by urine entering the abdominal cavity. Soon this leads to the emergence of diffuse urinary peritonitis, which, in the absence of treatment, inevitably results in death. In this situation, the patient is concerned about acute abdominal pain, muscle tension in the anterior abdominal wall, and lack of urge to urinate. If urine is excreted, then in a very small amount, mixed with blood and pus.

With traumatic bladder damage without its rupture, the clinical symptomatology is poorer. The trauma is manifested by minor pains over the pubis and the same slight violation of urination. In some cases, patients may complain of a small amount of blood in the urine sediment.

Even with minor damage to the lumbar region or pelvic area, immediate consultation of the urologist is necessary. The fact is that the symptoms of traumatic injury can occur after a while after the injury. The urologist should determine the degree of severity to calculate the possibility of complications.

Diagnosis of injuries of the urinary system

At the initial stage of the diagnosis of urinary tract damage, the radiographic survey of the of the abdominal organs is performed. It provides an opportunity to identify the presence of external objects and traumatic agents in the abdominal cavity and retroperitoneal space.

More detailed data can be obtained after carrying out excretory urography of .Let her not point out the structural changes in the renal parenchyma, but will give an opportunity to judge the functional state of the organ. As a rule, with bruises of the kidneys there is a violation of filtration in one of the organs, while at the rupture of the ureter, the contrast output beyond the ureter is visible.

The ultrasound examination of the organs of the retroperitoneal space provides an opportunity to determine the morphological state of the kidneys. The greatest attention in this case is paid to the state of the capsule, which can be torn or, in general, broken. To confirm the assumptions of ultrasound results, angiography of the kidney can be used, which shows the nature of the blood flow in this organ.

To confirm the rupture of the bladder, is used microcystography, the essence of which is the introduction of a contrast medium through the urethral catheter and the transmission of this part of the body with an X-ray device. In the case of rupture of the wall of the bladder, pouring of contrast medium into the cavity of the small pelvis is noted. Also, in the absence of an X-ray apparatus, a bladder rupture can be diagnosed by placing a conventional "balling" catheter into the abdominal cavity, from which urine dyed with blood will be excreted in this pathology.

Bladder rupture on the

micturition cystogram Among modern methods of diagnosing traumatic injuries of the urinary system, should be distinguished by computer tomography with the contrast of .It gives more accurate results, in contrast to the above-mentioned ultrasound and excretory urography, which have a lot of shortcomings.

In the presence of open injuries of the genitourinary system, when there is a wound channel, fistulography technique is used. It consists in filling the wound channel with diamond green or methylene blue for further revision of the latter.

Treatment of urinary tract trauma

Absolutely all patients with traumatic injuries of the urogenital system, regardless of their clinical condition, need mandatory admission to the profile department of .Here they are carefully monitored to identify complications and to prescribe the right treatment tactics, which can be conservative or operational.

Traumatic rupture of the kidney is treated with an operative intervention, during which the organ defect is sutured or the latter is removed. The operation, as a rule, ends with nephrostomy for urinary evacuation, which constantly seeps into the area of the postoperative wound. During the operation, a thorough audit of soft tissues must be carried out for the presence of outside objects, if it was an open trauma to the kidney.

Treatment of bladder rupture consists in carrying out an operation to suture the defect of its wall. An ordinary two-row seam is applied, which seals the cavity of the bladder. In the postoperative period, a good evacuation of urine from the bladder is very important in order not to increase the pressure inside the organ, which can contribute to the divergence of the seams applied to its wall.

In principle, operative treatment of ureter ruptures and urethra is nothing special. Here, the defect is also sutured, followed by adequate drainage.

Conservative treatment of all injuries of the urogenital system consists in the appointment of antibacterial and analgesic therapy. As the first can be used such drugs as Ceftriaxone, Gatifloxacin or Ofloxacin, and as the second - Analgin, Diclofenac or Ketanov. The course of conservative treatment depends on the severity of traumatic injury and subjective sensations of the patient.

Treatment of injuries of the urogenital system with folk remedies

The use of compresses on the area of traumatic injury with minor injuries can produce positive results. They relieve pain syndrome and contribute to the acceleration of resorption of the hematoma in the presence of the latter. The use of these methods for ruptures or bleeding is not only useless, but also dangerous, since it delays the use of qualified medical care. Therefore, apply compresses and any other folk methods of treatment can only after a urologist's consultation.

Features of Nutrition and Lifestyle

Restrict food in the food of patients with injuries to the organs of the excretory system only if they perform surgery. In this case, a diet number 0 is assigned, which implies complete fasting before surgery. This is done with the expectation that during anesthesia in patients often there is reflex vomiting, which complicates the operation process.

Rehabilitation after injury

Patients are advised to perform physiotherapeutic methods of treatment in the postoperative period. Doctors believe that carrying out UHF and darsonvalization speeds up the healing and recovery process.

Also mandatory, as with any other diseases, a course of treatment with drugs containing beneficial bacteria is prescribed. This is done on the basis that in patients after a prolonged course of antibiotic therapy, the normal intestinal microflora is disrupted.

Complications of injuries of the urinary system

The two most dangerous complications for these injuries are bleeding and peritonitis. The first can develop with the defeat of any of these organs, in the case of rupture of a large vessel. In this case, the blood is released into the cavity of the bladder or retroperitoneal space.

Peritonitis develops on the background of perforation of the wall of the bladder. Urine quickly fills all spaces and floors of the abdominal cavity, which leads to the development of serious inflammation, which can even have a lethal outcome.

Prevention of injuries of the urinary system

The most dangerous occupations in terms of injuries to the organs of the excretory system are motorcycle racers and builders. Therefore, during work, it is recommended that they follow the safety rules and use personal protective equipment.

In addition, kidney injuries often occur in car accidents. Thus, the installation of airbags can also be considered one of the types of injury prevention of the urinary system.

Rev.doctor urologist Astashin Е.Е.