1.  Dr Hawre Qadir Salih

2.  Morbid condition of the kidneys produced by external violence.

3. * 1%–5% of all traumas * Male to female 3:1

4.  Majority mild,can be managed conservatively

5.  Blunt 90 % *RTA *Falls *Vehicle-associated pedestrian accidents *Contact sports *Assault  Penetrating 10% *Gunshot *stab wounds

6.  1 - Contusion or nonexpanding sub capsular hematoma No laceration  2 - Nonexpanding perirenal hematoma Cortical laceration <1 cm deep without extravasations  3 - Cortical laceration >1 cm without urinary extravasations  4- Laceration: through corticomedullary junction into collecting system or Vascular: segmental renal artery or vein injury with contained hematoma or partial vessel laceration or vessels thrombosis  5- Laceration: shattered kidney or Vascular: renal pedicle avulsion

10. ABC History  Direct history *conscious *.  Witnesses and emergency personnel *unconscious * Physical examination  Vital signs  Site of trauma  Hematuria, flank ecchymoses,abrasions, fractured ribs, abdominal distension or tenderness, and palpable mass.

11. Investigations  Urinalysis  Hematocrit  baseline creatinine  US but no depth, no function Imaging: Criteria  gross hematuria  microscopic hematuria and shock  presence of major associated injuries

12.  If no CT available  Non functioning and, extravasations  Cheaper, more available

13.  Gold standard  location of injuries  contusions and devitalized segments  visualizes the entire retroperitoneum  associated hematomas  superior anatomical detail*depth and location of renal laceration *  associated abdominal and pelvic injuries

15.  Cost  Availability  Time consuming  Patient should be stable

16.  Hemodynamically unstable  In operation suite  2ml per kg  Single film after 10 min

18. Goals Minimize morbidity Preserve renal function

19.  Conservative  Surgical

20.  Majority of blunt trauma  Selected cases of penetrating trauma*grade I- II*  Bed rest, hydration, analgesia and antibiotic, serial physical examination and Hematocrit.

21.  Hemodynamic instability  Expanding or pulsatile perirenal hematoma  Penetrating injury  Less than 10% of blunt trauma need exploration

23.  Emergencies in urology  M. Hohenfellner · R.A. Santucci