Genitourinary and Splenic Hemorrhage: We’re Important Organs Too!

  • Stefan W. LeichtleEmail author
  • Kenji Inaba


Trauma to the genitourinary tract can affect the kidneys, ureters, bladder, and urethra. Of those, the kidneys are the most commonly injured organs with potential for significant blood loss. Considering this book’s focus on hemorrhage control, this chapter will therefore only discuss the management of kidney lacerations. In contrast to other solid organs, nonoperative management of high-grade renal lacerations is frequently successful and generally preferred. Isolated renal injuries causing hemodynamic instability are exceedingly rare, and a high index of suspicion should be maintained for the presence of associated injuries, particularly in blunt abdominal trauma. More often, kidney injuries are identified on abdominal computed tomography scan and can be managed nonoperatively with close monitoring and serial hemoglobin measurements. Intraoperatively, high-grade renal lacerations can present as zone II retroperitoneal hematoma and should only be explored in select circumstances.

The spleen is the most commonly injured organ in blunt trauma. Splenic injuries can be managed nonoperatively, with and without angiographic embolization, and operatively including splenorrhaphy, partial splenectomy, and splenectomy. Nonoperative management is more likely to be successful in isolated splenic injuries of low to moderate grade, while hemodynamic instability, peritonitis, and associated intracranial hemorrhage are absolute indications for splenectomy. In nonoperatively managed high-grade splenic injuries, follow-up should include repeat imaging to rule out the formation of pseudoaneurysms. After splenectomy the increased risk for infections in general, as well as the highly lethal postsplenectomy sepsis, requires attention.


Genitourinary trauma Renal laceration Splenic laceration Nonoperative management Operative exposure 


  1. 1.
    Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, Erickson BA, Holzbeierlein J, Hudak SJ, Pruitt JH, Reston JT, Santucci RA, Smith TG, Wessells H, American Urological A. Urotrauma: AUA guideline. J Urol. 2014;192(2):327–35. doi: 10.1016/j.juro.2014.05.004.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bukur M, Inaba K, Barmparas G, Paquet C, Best C, Lam L, Plurad D, Demetriades D. Routine follow-up imaging of kidney injuries may not be justified. J Trauma. 2011;70(5):1229–33. doi: 10.1097/TA.0b013e3181e5bb8e.CrossRefPubMedGoogle Scholar
  3. 3.
    Buckley JC, McAninch JW. Revision of current American Association for the Surgery of Trauma renal injury grading system. J Trauma. 2011;70(1):35–7. doi: 10.1097/TA.0b013e318207ad5a.CrossRefPubMedGoogle Scholar
  4. 4.
    Fiard G, Rambeaud JJ, Descotes JL, Boillot B, Terrier N, Thuillier C, Chodez M, Skowron O, Berod AA, Arnoux V, Long JA. Long-term renal function assessment with dimercapto-succinic acid scintigraphy after conservative treatment of major renal trauma. J Urol. 2012;187(4):1306–9. doi: 10.1016/j.juro.2011.11.103.CrossRefPubMedGoogle Scholar
  5. 5.
    Harbrecht BG, Ko SH, Watson GA, Forsythe RM, Rosengart MR, Peitzman AB. Angiography for blunt splenic trauma does not improve the success rate of nonoperative management. J Trauma. 2007;63(1):44–9. doi: 10.1097/TA.0b013e3180686531.CrossRefPubMedGoogle Scholar
  6. 6.
    Plurad DS, Green DJ, Inaba K, Benfield R, Lam L, Putty B, Demetriades D. Blunt assault is associated with failure of nonoperative management of the spleen independent of organ injury grade and despite lower overall injury severity. J Trauma. 2009;66(3):630–5. doi: 10.1097/TA.0b013e3181991aed.CrossRefPubMedGoogle Scholar
  7. 7.
    Rajani RR, Claridge JA, Yowler CJ, Patrick P, Wiant A, Summers JI, McDonald AA, Como JJ, Malangoni MA. Improved outcome of adult blunt splenic injury: a cohort analysis. Surgery. 2006;140(4):625–631.; discussion 631-622. doi: 10.1016/j.surg.2006.07.005.CrossRefPubMedGoogle Scholar
  8. 8.
    Weinberg JA, Magnotti LJ, Croce MA, Edwards NM, Fabian TC. The utility of serial computed tomography imaging of blunt splenic injury: still worth a second look? J Trauma. 2007;62(5):1143–1147.; discussion 1147-1148. doi: 10.1097/TA.0b013e318047b7c2.CrossRefPubMedGoogle Scholar
  9. 9.
    Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38(3):323–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hurst JM, Crookes BA, Harrington DT, Gregg SC, Brotman S, Burke PA, Davis KA, Gupta R, Winchell RJ, Desjardins S, Alouidor R, Gross RI, Rosenblatt MS, Schulz JT, Chang Y. Management of the most severely injured spleen: a multicenter study of the research consortium of New England centers for trauma (ReCONECT). Arch Surg. 2010;145(5):456–60. doi: 10.1001/archsurg.2010.58.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohn SM, Arango JI, Myers JG, Lopez PP, Jonas RB, Waite LL, Corneille MG, Stewart RM, Dent DL. Computed tomography grading systems poorly predict the need for intervention after spleen and liver injuries. Am Surg. 2009;75(2):133–9.PubMedGoogle Scholar
  12. 12.
    Moore FA, Davis JW, Moore EE Jr, Cocanour CS, West MA, McIntyre RC Jr. Western trauma association (WTA) critical decisions in trauma: management of adult blunt splenic trauma. J Trauma. 2008;65(5):1007–11. doi: 10.1097/TA.0b013e31818a93bf.CrossRefPubMedGoogle Scholar
  13. 13.
    Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ Jr, Sangosanya A, Schuster KM, Seamon MJ, Tchorz KM, Zarzuar BL, Kerwin AJ, Eastern Association for the Surgery of T. Selective nonoperative management of blunt splenic injury: an eastern Association for the Surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S294–300. doi: 10.1097/TA.0b013e3182702afc.CrossRefPubMedGoogle Scholar
  14. 14.
    Edgren G, Almqvist R, Hartman M, Utter GH. Splenectomy and the risk of sepsis: a population-based cohort study. Ann Surg. 2014;260(6):1081–7. doi: 10.1097/SLA.0000000000000439.CrossRefPubMedGoogle Scholar
  15. 15.
    Demetriades D, Scalea TM, Degiannis E, Barmparas G, Konstantinidis A, Massahis J, Inaba K. Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study. J Trauma Acute Care Surg. 2012;72(1):229–34. doi: 10.1097/TA.0b013e31823fe0b6.CrossRefPubMedGoogle Scholar
  16. 16.
    Demetriades D, Inaba K, Velmahos G. Atlas of surgical techniques in trauma. Cambridge: Cambridge University Press; 2015.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Acute Care Surgical ServicesVirginia Commonwealth University Medical CenterRichmondUSA
  2. 2.Division of Trauma & Critical CareLAC+USC Medical CenterLos AngelesUSA

Personalised recommendations