Penetrating Injuries To The Kidneys, Ureters, Or Bladder

What are penetrating injuries to the kidneys, ureters, or bladder?

  • Penetrating injuries are also called piercing injuries. These may be caused by anything that goes through the skin and into the body. Piercing injuries to the abdomen (stomach) and lower back area may injure the kidneys, ureters, or bladder. Injuries may include a tear, bruise, or, in severe cases, a ruptured kidney or bladder. The organ's blood vessels may also be affected. A piercing injury may also cut or put a hole in the ureter. Any of these injuries may lead to internal bleeding.

  • The kidneys are bean-shaped organs that remove unwanted chemicals and waste from your blood. These wastes are turned into urine by the kidneys. There is one kidney located on each side of the spine (backbone) in the back of your abdomen. The ureters are tubes that carry urine from the kidneys to the bladder. The bladder is a hollow, round organ that holds urine. It is small and when empty, lies behind the pelvic bone in the front of the abdomen. When the bladder is full, it becomes round and it goes up into the lower part of the abdomen. Among the three, the kidneys are the most commonly injured.

What causes piercing injuries to the kidneys, ureters, or bladder?

Piercing injuries to the kidneys, ureters, or bladder are most commonly caused by gunshot wounds. Stab wounds or objects going through the skin and into the abdomen may also cause organ injuries. These objects may include shrapnel, spikes, broken bones, and other pointed objects.

What are the signs and symptoms of piercing injuries to the kidneys, ureters, or bladder?

  • Abdominal pain, especially in the lower abdomen or lower back area. Your abdomen may also be tender and hard.

  • Bleeding from an open wound. There may be more than one open wound where a bullet may have entered and exited.

  • Blood in the urine or pink-to-red colored urine.

  • Bruising, swelling, or scratches on the abdomen over the injured area.

  • Fever, nausea (upset stomach), or vomiting (throwing up).

  • Signs of shock, including a fast pulse (heartbeat), low blood pressure, and pale skin.

  • Trouble urinating or passing little to no urine.

How are piercing injuries to the kidneys, ureters, or bladder diagnosed?

Your caregiver will do a complete check-up of your body to look for open wounds or signs of injury. Certain tests use a special dye to help organs and structures show up better. Tell caregivers if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye. One or more of the following tests may be done:

  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

  • Urine test: A sample of your urine is collected and tested for blood in your urine.

  • Imaging tests:

    • Abdominal ultrasound: This test is done so caregivers can see the tissues and organs of your abdomen. Gel will be put on your abdomen and a small sensor will be moved across your abdomen. The sensor uses sound waves to send pictures of your abdomen to a TV-like screen.

    • Angiography: This test looks for problems with blood flow in your abdomen. A catheter (long, thin, bendable tube) is placed in a blood vessel in your groin. The groin is the area where your abdomen meets your upper leg. A dye is put into the catheter. Pictures are taken using an x-ray or a CT scan after the dye goes to your abdominal organs.

    • Computerized tomography scan: This is also called CT scan. A special X-ray machine uses a computer to take pictures of different areas of your abdomen and pelvis. It may be used to look at your bones, organs, and blood vessels. Before taking the pictures, you may be given dye through an IV in your vein.

    • Cystogram: This is an x-ray test during which a catheter is put into your bladder. Dye is put through the catheter into your bladder while x-rays are being taken. The size and shape of your bladder can be seen on the x-rays. The x-rays also show how much urine your bladder can hold. Caregivers will also look to see if urinary reflux is happening. Urinary reflux is when urine backs up from the bladder into your ureters and kidneys. This reflux may cause a kidney infection.

    • Cystoscopy: A cystoscopy allows caregivers to look for problems inside your bladder. A cystoscope is put into your bladder through your urethra. The urethra is the tube that urine flows through when you urinate. The cystoscope is a long tube with a lens and a light on the end. The scope may be hooked to a camera or monitor, and pictures may be taken. A tissue sample may also be taken during your cystoscopy. During this test, small tumors may be removed or bleeding may be stopped.

    • KUB x-ray: This is an x-ray picture of your kidneys, ureters, and bladder. Caregivers use this picture to help find any problems with your kidneys, ureters, bladder, or abdomen. You may be given dye as a shot into your vein. This dye will help these organs show up better in x-ray pictures. A KUB x-ray with dye is called an intravenous pyelogram (IVP).

    • Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your abdomen. During an MRI, pictures are taken of your bones, abdominal or pelvic organs, or blood vessels. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.

How are piercing injuries to the kidneys, ureters, or bladder treated?

  • Watchful waiting: If your condition is stable and your injury is mild, watchful waiting may be all that is needed. Your caregiver will watch you closely for a period of time until your injury heals on its own. You may need to rest in bed and limit your activity.

  • Embolization: This is done to stop bleeding from an injured blood vessel. After doing an angiography, caregivers block off the bleeding by injecting a liquid, coil, or gel into the vessel.

  • Surgery: Open or laparoscopic surgery may be done to clean and repair an injured organ. Caregivers may use sutures (threads) to close a cut. Bleeding from blood vessels may be stopped by applying heat or closing them with sutures. A ureter, that is cut into two, may have its ends reattached. Surgery to take out all or part of the injured kidney, ureter, or bladder may be done. Sometimes, surgery to correct other problems or treat other injuries may be done first. You may need to have more than one surgery.
With treatment, such as surgery, your kidneys, ureters, or bladder may heal over time, and serious problems may be prevented.

Where can I find more information?

Having a piercing injury to the kidneys, ureters, or bladder may be hard. You and those close to you may feel scared, sad, or angry. These are normal feelings. Contact the following for more information:

  • American College of Surgeons
    633 N. Saint Clair St.
    Chicago , IL 606113211
    Phone: 1- 312 - 2025000
    Phone: 1- 800 - 6214111
    Web Address:

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

Learn more about Penetrating Injuries To The Kidneys, Ureters, Or Bladder