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DOI: 10.1055/s-0031-1296084
The Role of Interventional Radiology in Urologic Tract Trauma
Publication History
Publication Date:
03 January 2012 (online)

ABSTRACT
The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. Several classification systems convey the severity of injury to kidneys, ureter, bladder, and urethra. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according the size of laceration and its proximity to the renal hilum. Ureteral injury is graded according to its extent relative to the circumference of the ureter and the extent of associated devascularization. Bladder injury is graded according to its location relative to the peritoneum. Urethral injury is graded according to the extent of damage to surrounding anatomic structures. Although these classification schema may not be always used in common parlance, they do help delineate most important features of urologic tract injury that impact patient management and interventions.
KEYWORDS
Kidney - trauma - embolization - interventional radiology - genitourinary
REFERENCES
- 1
Titton R L, Gervais D A, Boland G W, Mueller P R.
Renal trauma: radiologic evaluation and percutaneous treatment of nonvascular injuries.
AJR Am J Roentgenol.
2002;
178
(6)
1507-1511
Reference Ris Wihthout Link
- 2
Bixby S D, Callahan M J, Taylor G A.
Imaging blunt pediatric blunt abdominal trauma.
Semin Roentgenol.
2008;
43
(1)
72-82
Reference Ris Wihthout Link
- 3
McAleer I M, Kaplan G W, LoSasso B E.
Congenital urinary tract anomalies in pediatric renal trauma patients.
J Urol.
2002;
168
(4 Pt 2)
1808-1810
discussion 1810
Reference Ris Wihthout Link
- 4
Lorelli D R, Kralovich K A, Seguin C.
The impact of pre-existing end-stage renal disease on survival in acutely injured
trauma patients.
Am Surg.
2001;
67
(7)
693-696
Reference Ris Wihthout Link
- 5
Patel M S, Malinoski D J, Nguyen X M, Hoyt D B.
The impact of select chronic diseases on outcomes after trauma: a study from the National
Trauma Data Bank.
J Am Coll Surg.
2011;
212
(1)
96-104
Reference Ris Wihthout Link
- 6
Santucci R A, Fisher M B.
The literature increasingly supports expectant (conservative) management of renal
trauma—a systematic review.
J Trauma.
2005;
59
(2)
493-503
Reference Ris Wihthout Link
- 7
Natarajan B, Gupta P K, Cemaj S, Sorensen M, Hatzoudis G I, Forse R A.
FAST scan: is it worth doing in hemodynamically stable blunt trauma patients?.
Surgery.
2010;
148
(4)
695-700
discussion 700-701
Reference Ris Wihthout Link
- 8
Sangthong B, Demetriades D, Martin M et al..
Management and hospital outcomes of blunt renal artery injuries: analysis of 517 patients
from the National Trauma Data Bank.
J Am Coll Surg.
2006;
203
(5)
612-617
Reference Ris Wihthout Link
- 9
Breyer B N, McAninch J W, Elliott S P, Master V A.
Minimally invasive endovascular techniques to treat acute renal hemorrhage.
J Urol.
2008;
179
(6)
2248-2252
discussion 2253
Reference Ris Wihthout Link
- 10
Bent C, Iyngkaran T, Power N et al..
Urological injuries following trauma.
Clin Radiol.
2008;
63
(12)
1361-1371
Reference Ris Wihthout Link
- 11
Toutouzas K G, Karaiskakis M, Kaminski A, Velmahos G C.
Nonoperative management of blunt renal trauma: a prospective study.
Am Surg.
2002;
68
(12)
1097-1103
Reference Ris Wihthout Link
- 12
Hagiwara A, Sakaki S, Goto H et al..
The role of interventional radiology in the management of blunt renal injury: a practical
protocol.
J Trauma.
2001;
51
(3)
526-531
Reference Ris Wihthout Link
- 13
Morita S, Inokuchi S, Tsuji T et al..
Arterial embolization in patients with grade-4 blunt renal trauma: evaluation of the
glomerular filtration rates by dynamic scintigraphy with 99m Technetium-diethylene
triamine pentacetic acid.
Scand J Trauma Resusc Emerg Med.
2010;
18
11
Reference Ris Wihthout Link
- 14
Chow S J, Thompson K J, Hartman J F, Wright M L.
A 10-year review of blunt renal artery injuries at an urban level I trauma centre.
Injury.
2009;
40
(8)
844-850
Reference Ris Wihthout Link
- 15
Brewer Jr M E, Strnad B T, Daley B J et al..
Percutaneous embolization for the management of grade 5 renal trauma in hemodynamically
unstable patients: initial experience.
J Urol.
2009;
181
(4)
1737-1741
Reference Ris Wihthout Link
- 16
Savastano S, Feltrin G P, Miotto D, Chiesura-Corona M.
Renal aneurysm and arteriovenous fistula. Management with transcatheter embolization.
Acta Radiol.
1990;
31
(1)
73-76
Reference Ris Wihthout Link
- 17
Dobrilovic N, Bennett S, Smith C, Edwards J, Luchette F A.
Traumatic renal artery dissection identified with dynamic helical computed tomography.
J Vasc Surg.
2001;
34
(3)
562-564
Reference Ris Wihthout Link
- 18
Lee J T, White R A.
Endovascular management of blunt traumatic renal artery dissection.
J Endovasc Ther.
2002;
9
(3)
354-358
Reference Ris Wihthout Link
- 19
Lupattelli T, Basile A, Iozzelli A et al..
Thrombolytic therapy followed by stenting for renal artery dissection secondary to
blunt trauma.
Emerg Radiol.
2005;
11
(3)
164-166
Reference Ris Wihthout Link
- 20
Best C D, Petrone P, Buscarini M et al..
Traumatic ureteral injuries: a single institution experience validating the American
Association for the Surgery of Trauma-Organ Injury Scale grading scale.
J Urol.
2005;
173
(4)
1202-1205
Reference Ris Wihthout Link
- 21
Vaccaro J P, Brody J M.
CT cystography in the evaluation of major bladder trauma.
Radiographics.
2000;
20
(5)
1373-1381
Reference Ris Wihthout Link
- 22
Martínez-Piñeiro L, Djakovic N, Plas E European Association of Urology et al.
EAU guidelines on urethral trauma.
Eur Urol.
2010;
57
(5)
791-803
Reference Ris Wihthout Link
- 23
Brown S L, Elder J S, Spirnak J P.
Are pediatric patients more susceptible to major renal injury from blunt trauma? A
comparative study.
J Urol.
1998;
160
(1)
138-140
Reference Ris Wihthout Link
- 24
Margenthaler J A, Weber T R, Keller M S.
Blunt renal trauma in children: experience with conservative management at a pediatric
trauma center.
J Trauma.
2002;
52
(5)
928-932
Reference Ris Wihthout Link
- 25
Eassa W, El-Ghar M A, Jednak R, El-Sherbiny M.
Nonoperative management of grade 5 renal injury in children: does it have a place?.
Eur Urol.
2010;
57
(1)
154-161
Reference Ris Wihthout Link
- 26
Sahai A, Cuthbert F, Niekrash R, Siddiqui M, Gulati M S.
Endovascular management of grade V blunt renal trauma with associated splenic injury.
Nat Rev Urol.
2009;
6
(6)
335-337
Reference Ris Wihthout Link
- 27
Lin P H, Dodson T F, Bush R L et al..
Surgical intervention for complications caused by femoral artery catheterization in
pediatric patients.
J Vasc Surg.
2001;
34
(6)
1071-1078
Reference Ris Wihthout Link
Naganathan B.S. ManiM.D.
Mallinckrodt Institute of Radiology, Section of Vascular and Interventional Radiology
510 S. Kingshighway Blvd., Campus Box 8131 St. Louis, MO 63110
Email: manin@mir.wustl.edu