American Medical Association Family Medical Guide - American Medical Association [535]
Injury to the Kidneys or the Ureters
Injury to the kidneys or the ureters (the muscular tubes that carry urine from the kidneys to the bladder) usually results from a direct blow to the side of the body or a crushing force (such as from a motor vehicle collision). Another possible cause of injury is penetration by a sharp object (such as a knife) or a bullet. In any injury, a kidney may be bruised or its tissue torn or fractured. The ureters also may be bruised, obstructed, or torn. Sometimes a large blood clot forms under the fibrous capsule that surrounds the kidney and produces a lump over the kidney. It is also possible for blood or urine to leak into the abdomen through a tear in a kidney or a ureter.
Symptoms and Diagnosis
A slight injury to a kidney or a ureter may cause pain and tenderness in the lower part of your back. You may have a fever and notice occasional traces of blood in your urine (you may not see any blood until a day or two after the injury). If you have severe pain or large amounts of blood in your urine, you may have a serious injury to one or both kidneys and possibly the ureters.
If you have a kidney or bladder injury, your doctor will probably order diagnostic tests such as an ultrasound (see page 111) or a CT scan (see page 112) to evaluate the severity of the injury and determine the best course of treatment.
Treatment
Because the kidneys are often able to heal themselves, even major tears and injuries usually require no treatment other than 7 to 10 days of bed rest. Your doctor will probably recommend that you stay in the hospital for several days to allow him or her to monitor your pulse, blood pressure, and blood count, and to check your urine frequently for signs of severe internal bleeding.
Surgery to repair a damaged ureter is usually performed immediately. If your kidney does not heal on its own after a period of bed rest, the doctor may perform surgery to remove it. The remaining healthy kidney may increase in size and level of function and do the work of both kidneys.
Injury to the Bladder or the Urethra
Because the bladder is low inside the pelvis, it is usually protected from injury. When an injury does occur, it generally results from a direct blow to the pelvis that fractures a pelvic bone and causes a sharp fragment of the bone to pierce the bladder wall, or from a direct, forceful blow to a full bladder that causes the bladder to rupture. The bladder can occasionally be damaged during abdominal surgical procedures such as a cesarean section (see page 534) or laparoscopy. These injuries can be serious if urine leaks from the bladder into the abdominal cavity.
Location of the bladder
The bladder is a hollow organ that serves as the temporary storage site for urine. It lies behind the pubic bone and is protected by the circle of bones that form the pelvis.
Because the male urethra (the tube that carries urine from the bladder out of the body) is longer than the female urethra, rupture of the urethra occurs more frequently in men than in women. A ruptured urethra can result from a fall or any other kind of serious injury to the pelvis. This type of injury usually occurs in a motor vehicle collision that fractures the pelvis.
Rupture of the bladder is dangerous because urine can leak into the abdominal cavity and cause peritonitis (see page 759). This condition requires prompt treatment in a hospital. Damage to the urethra, however, usually does not lead to peritonitis. For a man, the major risks of damage to the urethra are narrowing of the urethra from scarring or inflammation (urethral stricture; see page 837) and erection problems (see page 486).
Symptoms
A ruptured bladder causes severe abdominal pain. The condition also may produce symptoms of peritonitis—such as fever, bloating, or nausea and vomiting—and of shock (see page 579)—such as sweating, faintness, shallow breathing, rapid pulse, or pale, cold, clammy skin. A ruptured bladder usually results in the