Renal trauma research has historically focused on parenchymal injuries and the risk of bleeding. However, much less is known about the diagnosis and optimal management of urinary extravasation, which complicates ~30% of high-grade renal injuries. Immediate or delayed ureteral stenting is the most common procedure used to treat collecting system injuries when intervention is needed. However, the lack of evidence-based guidelines leaves the diagnosis and management of urinary extravasation largely dependent upon physicians’ experience, initial and follow-up imaging protocols, and the definitions used for grading the injuries. The knowledge gaps in the management of urinary extravasation that need to be addressed include the timing of excretory-phase CT imaging, patterns of clinically significant urinary extravasation, predictors of complications when urinary extravasation occurs, protocols for obtaining and interpreting follow-up imaging, and the role of ureteral stenting and other interventions in management. To improve the management of urinary extravasation after high-grade renal trauma, large, multi-institutional prospective trails assessing different diagnostic and therapeutic protocols are needed.

肾脏外伤研究历来集中在实质损伤和出血风险上。但是，关于尿液外渗的诊断和最佳治疗的知识知之甚少，这使约30％的高度肾脏损伤复杂化。当需要干预时，立即输尿管支架置入术或延迟输尿管支架置入术是治疗收集系统损伤的最常用方法。然而，由于缺乏循证指南，尿液外渗的诊断和处理很大程度上取决于医生的经验，初始和后续的影像学检查方案以及对伤情分级的定义。尿液外渗处理的知识差距需要解决，包括排泄期CT成像的时间安排，临床上重要的尿液外渗模式，发生尿液外渗时的并发症预测指标，获取和解释随访影像的方案以及输尿管支架置入术和其他干预措施的作用。为了改善严重肾脏损伤后尿液渗出的管理，需要大型，多机构的前瞻性研究评估不同的诊断和治疗方案。