CT with intravenous contrast material remains the primary imaging modality for penetrating trauma to the kidneys. It usually shows appropriate detail of injury to inform management decisions. At least one study has shown its utility for staging even penetrating injuries, allowing nonoperative management in selected patients (i.e., those with minor injury).18 As with blunt trauma, sonography has no accepted role for detection or staging of renal injury in the United States at this time.
Ureteral injuries can be assessed by IVP or CT with contrast. Extravasation indicates injury. CT has the added advantage of being able to evaluate the extent of extravasation and other intraabdominal injuries. As with blunt trauma, cystography (plain film or CT) is required to evaluate penetrating injuries of the bladder. Unstable patients who require emergency laparotomy can undergo a "one-shot" IVP while in the operating room.
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