Single shot intraoperative excretory urography for the immediate evaluation of renal trauma.
ABSTRACT We reviewed the quality and usefulness of single shot intraoperative excretory urography (IVP) for evaluating suspected upper urinary tract trauma at our trauma center.
Between 1990 and 1997 single shot intraoperative IVP for staging renal injuries was performed in 50 patients in whom clinical instability and/or major associated injuries mandated an intraoperative study. Contrast material (2 ml/kg) was injected intravenously and images were obtained after 10 minutes. The quality and usefulness of each study were scored by a single attending urologist on a scale of 1-worst to 5-best.
Intraoperative study quality was generally good (average score 3.84). The information obtained was generally considered useful for determining urological treatment (average score 3.96). In 16 patients (32%) intraoperative IVP findings safely obviated renal exploration. No contrast medium reactions were noted and no complications developed that were attributable to intraoperative IVP.
Intraoperative single shot, high dose IVP is safe, efficient and of high quality in the majority of cases when performed as recommended. This study often provides important information that facilitates rapid and accurate decision-making. Intraoperative IVP is a useful tool for guiding the exploration of penetrating renal injuries and confirming blunt renal injuries that may be safely observed.
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ABSTRACT: Renal injury is observed in 10 percent of cases of abdominal trauma, and the majority (80 percent to 90 percent) of these are attributable to blunt trauma. Intravenous urography and ultrasonography of the abdomen were previously the modalities of choice in the imaging of renal injuries. However, computed tomography (CT) is currently the imaging modality of choice in the evaluation of blunt renal injury, since it provides the exact staging of renal injuries. The purpose of this article is to describe the CT staging of renal injuries observed in blunt abdominal trauma based on the Federle Classification and the American Association for the Surgery of Trauma renal injury severity scale.Singapore medical journal 06/2010; 51(6):468-73; quiz 474. · 0.63 Impact Factor
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ABSTRACT: A 7-year-old previously healthy girl was injured in a traffic accident and presented to the emergency room with abdominal pain, microscopic hematuria, and wide skin defects and deep lacerations on the left flank, left upper abdomen, and right inguinal area. Initial CT of the abdomen was unremarkable. 3 weeks later, the patient complained of abdominal distension, left flank pain, and fever. Blood and urine tests, CT of the abdomen, chest X-ray, antegrade pyelography, intravenous urography, renal ultrasonography and diuretic renal scan. Complete avulsion injury of the left ureteropelvic junction. The patient underwent 11 plastic reconstructive surgeries, including a skin grafting operation. A percutaneous nephrostomy was performed for temporary diversion. After complete healing of the left flank wound, open pyeloplasty was performed to create a ureteropelvic anastomosis with stent. The patient was discharged 1 week after surgery and the stent was removed 5 weeks later. 5 years after pyeloplasty, her renal function was normal and she had experienced no complications.Nature Reviews Urology 10/2009; 6(9):509-12. · 4.79 Impact Factor
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ABSTRACT: Trauma is the leading cause of death between the ages of 1 and 44 years in the USA. While stabilization of life-threatening injuries is the primary goal in the evaluation of all trauma patients, subsequent diagnosis and treatment of secondary injuries are requirements for good trauma care. The genitourinary system is involved in 10% of trauma cases, and these injuries can be associated with considerable morbidity and mortality. Accordingly, physicians involved in the initial evaluation and subsequent management of trauma patients should be aware of the diagnosis and treatment of injuries that can occur in the genitourinary system. In 2009, the European Association of Urology provided specific recommendations for the evaluation, diagnosis and management of genitourinary trauma. Here, we review and discuss these recommendations in order to provide a concise summary for clinicians involved in the evaluation and management of trauma patients and their associated genitourinary injuries.Nature Reviews Urology 09/2010; 7(9):510-9. · 4.79 Impact Factor