Editing Upper Urinary Tract Trauma (section)

=== Diagnosis and evaluation ===

==== <span style="color:#ff0000">History and physical exam ====

* Hematuria is a non-specific indicator of urologic injury 
* '''Significant ureteral injury can occur in the absence of hematuria'''
* '''<span style="color:#ff0000">Post-operative signs and symptoms of missed ureteral injury (6):''' 
*#'''<span style="color:#ff0000">Flank pain'''
*# '''<span style="color:#ff0000">Fever'''
*# '''<span style="color:#ff0000">Leukocytosis'''
*# '''<span style="color:#ff0000">Ileus'''
*# '''<span style="color:#ff0000">Abdominal distention'''
*# '''<span style="color:#ff0000">Urinary fistula'''

==== <span style="color:#ff0000">Imaging ====

* '''<span style="color:#ff0000">Indications (contrast enhanced CT with 10 minute delayed films) for imaging (1)''' (AUA)
*# '''Stable trauma patients with suspected ureteral injuries and not proceeding directly to laparotomy'''
**If the initial delayed images do not adequately opacify the ureters, further delayed imaging may be necessary if ureteral injury is still suspected.

* '''<span style="color:#ff0000">Findings suggestive of ureteral injury (4):''' 
*#'''<span style="color:#ff0000">Contrast extravasation'''
*# '''<span style="color:#ff0000">Lack of contrast in the ureter distal to the suspected injury'''
*# '''<span style="color:#ff0000">Ipsilateral delayed pyelogram'''
*# '''<span style="color:#ff0000">Ipsilateral hydronephrosis'''

==== <span style="color:#ff0000">Other</span> ====

* '''<span style="color:#ff0000">Direct inspection during laparotomy in trauma patients with suspected ureteral injury who have not had preoperative imaging</span>'''