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Urinary Tract Injuries

The urinary system comprised of kidneys, ureters, bladder, and urethra purifies the blood by removing the waste substances and the waste substances are excreted out of the body in the form of urine. Injury to the organs of urinary tract may impair the regular functioning of these organs leading to further complications. Urinary tract injuries can occur from blunt trauma (such as a blow to the body from motor vehicle collisions, falls, or sports injuries), penetrating wounds (such as bullet or stab wounds), or unintentional injuries during surgery. Urinary tract injuries are often accompanied by injuries of the surrounding organs, predominantly the abdominal organs. In some cases, the penis and testes, organs of male reproductive system may also be injured. Urinary tract injuries can lead to complications such as bleeding, urine leakage, and infection.

Bladder injuries: Any major or high-impact blow to the pelvis may cause bladder injuries. Bladder injuries may also occur unintentionally during surgeries of the pelvis or lower abdomen such as hysterectomy, caesarean section, or colectomy. Patients with bladder injuries may have symptoms such as haematuria (blood in urine), painful or difficulty in urination, and lower abdominal pain. In case of injuries to the lowest part of bladder, patients suffer urinary incontinence, a condition of uncontrollable passage of urine. Treatment for bladder injuries depends on the severity of injury. If the injuries are mild, the condition can be treated by inserting catheters for 5 to 10 days to drain the urine allowing the healing however in severe cases surgical repair will be performed followed by catheterization for 7 to 10 days. However if the injuries are left untreated may lead to further complications such as urgent urination, urinary incontinence (inability to control the passage of urine), and infections.

Kidney injuries: The kidney is the most common organ in the urinary tract to be injured. The common causes include the motor vehicle accidents, accidental falls, sports injuries, stabbed wound or bullet wounds. Rarely these injuries can also occur during various diagnostic procedures such as kidney biopsy or treatment procedures for kidney stones. If left untreated, severe injuries can cause kidney failure, high blood pressure, delayed bleeding, and infection. The symptoms of a kidney injury may include bruises and pain in upper abdomen or flank (area between the ribs and hip) region, blood in the urine, marks near a kidney made by a seat belt, or pain from fractures of the lower ribs. Low blood pressure and anaemia may occur in case of severe injury if more volume of blood is lost because of injury. Treatment depends on the type and severity of injury. Minor injury to the kidney may heal itself by bed rest and controlling fluid intake. For severe injuries, measures are taken to avoid blood loss and prevent shock. In addition intravenous infusions or blood transfusion may be required to maintain the normal blood pressure as well to stimulate the urine production. In more severe cases, surgery is needed to repair damaged tissue and blood vessels or the damaged kidney may be removed.

Ureteral injuries: These injuries occur during diagnostic procedure such as ureteroscopy, during pelvic or abdominal surgeries, and gunshots or stabbed wounds. Rarely these injuries can also occur from direct blow. The complications of ureteral injuries are formation of fistula (abnormal connection to another abdominal structure), narrowing (stricture) of the urethra, persistent urinary leakage and infection. The common symptoms of ureteral injury include abdominal or flank pain, urine leakage, fever, infection, and blood in the urine. Minor injuries are treated with placement of stent in the ureter to divert the urine from ureters for 2 to 6 weeks allowing them to heal. For severe injuries, surgery is needed to repair the damage or to reconstruct the ureter.

Urethral injuries: These injuries can occur as a result of straddle- type falls (injuries to the area between the legs) or pelvic fractures.These injuries can also occur during procedures such as bladder catheterization, cystoscopy or during surgeries performed on urethra. If the urethra is injured, a person may develop bloody discharge from tip of the penis in men or the urethral opening in women, blood in the urine, bruising, painful urination or inability to urinate. Untreated urethral injuries can lead to complications such as bleeding, permanent narrowing of the urethra, inability to have an erection (erectile dysfunction), urinary incontinence, and infection. Urethral injuries can be treated with the insertion of a catheter into the bladder, which is usually left in place for several days while the urethra heals. In the case of severe urethral injury, the injury may need to be repaired with surgery.

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