About 10 percent of patients with renal injury related to stab wounds may not manifest hematuria. Thus, appropriate evaluation depends on clinical suspicion, the weapon involved, and patient characteristics. Generally, all stable patients with penetrating trauma with the potential of renal system injury should undergo imaging studies. Hematuria, microscopic or gross, does not correlate with injury from penetrating trauma.17 The choice of imaging depends on the vicinity of the trauma. Thus, its presence alone mandates further evaluation.
Ureteral injuries are usually a result of bullet wounds. Again, hematuria is not a reliable finding in this setting. Imaging is required for penetrating injuries near ureters. Contusions from secondary energy forces related to bullets cannot be detected by imaging. They may come to light during surgical exploration.
Penetrating bladder injuries are usually accompanied by gross hematuria. As with other penetrating trauma, in the absence of hematuria, the need to perform imaging studies is driven by clinical concern.
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