Editing Upper Urinary Tract Trauma (section)

==== Special Scenarios ====
===== Renal injury with urinary extravasation =====
*'''<span style="color:#ff0000">Persistent urinary extravasation can result in:'''
*#'''<span style="color:#ff0000">Urinoma'''
*#'''<span style="color:#ff0000">Perinephric infection'''
*#'''<span style="color:#ff0000">Renal loss (rarely)'''
*'''Stable patients where renal pelvis or proximal ureteral injury is not suspected: observation (AUA)'''
**'''Parenchymal collecting system injuries often resolve spontaneously.'''
***Urinary extravasation alone from a grade IV parenchymal laceration or forniceal rupture managed non-operatively has a spontaneous resolution of > 90%
*'''<span style="color:#ff0000">Indications for intervention (4):</span>'''
*#'''<span style="color:#ff0000">Suspected injury to renal pelvis or proximal ureteral avulsion</span>'''
*#*'''<span style="color:#ff0000">Suggested by large medial urinoma or contrast extravasation on delayed images without distal ureteral contrast</span>'''
*#*'''Management is either endoscopic or open depending on the clinical scenario'''
*#'''<span style="color:#ff0000">Urinoma increasing in size, purulence, or complexity</span> on follow-up imaging'''
*#'''<span style="color:#ff0000">Presence of complications such as fever, infection, increasing pain, ileus, or fistula.</span>'''
*# '''Severe renal injuries with <span style="color:#ff0000">continued urinary extravasation</span>''' (not described in 2020 AUA Guidelines)
*#*'''Placement of an internal ureteral stent for drainage may prevent prolonged urinary extravasation and decrease the chance of perirenal urinoma formation'''
* '''<span style="color:#ff0000">Options for intervention'''
*#'''<span style="color:#ff0000">Ureteral stent (preferred)'''
*#*An internalized ureteral stent is minimally invasive and alone may provide adequate drainage of the injured kidney
*#*'''A period of concomitant Foley catheter drainage may minimize pressure within the collecting system and enhance urinoma drainage'''
*# '''Percutaneous urinoma drain, percutaneous nephrostomy, or both may also be necessary'''

===== <span style="color:#ff0000">Hypertension and Renal Trauma</span> =====
*'''Hypertension is rarely noted in the early postinjury period but can occur later.'''
*'''<span style="color:#ff0000">Mechanisms for hypertension as a complication of renal trauma (4):</span>'''
*#'''<span style="color:#ff0000">Renal vascular injury, leading to stenosis or occlusion of the main renal artery or one of its branches</span>''' (one-clip, Goldblatt kidney)
*#'''<span style="color:#ff0000">Page kidney: compression of the renal parenchyma with extravasated blood or urine</span>'''
*#'''<span style="color:#ff0000">Post-trauma arteriovenous fistula</span>'''
*#'''<span style="color:#ff0000">Ureteral / UPJ obstruction</span>[https://www.ncbi.nlm.nih.gov/pubmed/29959876]'''
*#*In the first 3 scenarios, the renin-angiotensin axis is stimulated by partial renal ischemia, resulting in hypertension
* '''Can be treated with (3):'''
*#'''Anti-hypertensives'''
*#'''Observation'''
*#'''Nephrectomy (uncommonly)'''