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: The purpose of this study is to describe the clinical characteristics of patients diagnosed with renal trauma at Hospital Universitario Del Valle (HUV) in Cali, Colombia. This is a descriptive study of patients diagnosed with renal trauma (ICD 10) at HUV between 1 January 2003 and 31 December 2007. We gathered such variables as age, sex, haemodynamic stability, type of trauma, location and effect of injury, clinical examination findings at admission, presence of renal failure, need for transfusion, diagnostic method, accompanying injuries, required treatment, duration of hospital stay and complications. Statistical analysis was performed using SPSS v. 15. 106 patients were evaluated, 78.3% of whom were male; mean age was 30.5 years. The majority were admitted for blunt trauma (73.6%) mainly due to motorcycle accidents and falls from heights. Minor trauma (Grades 1-3) was found in 77.3% of cases, haematuria in 90% and flank pain in 64%. A CT scan was used in 69.8% of all cases. Conservative treatment was employed in 77.4% of the cases, mainly for minor trauma (P < .0001); of these, 12% subsequently required surgery. Acute abdominal pain was the main surgical indication. Procedures were as follows: Nephropexy (32%) nephrectomy (38%) and conservative treatment (26%). The main complication was rebleeding (3.8%). Minor trauma is the most frequent kind of kidney injury, and is usually present with associated injuries. Conservative treatment was administered to most patients, but the failure rate was 12% and the frequency of overall complications was 10%.Actas urologicas españolas 09/2009; 33(8):881-7. · 1.14 Impact Factor
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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
Article: Nierentrauma[Show abstract] [Hide abstract]
ABSTRACT: Die meisten Nierenverletzungen in den industrialisierten Staaten werden durch ein stumpfes Trauma verursacht. Die Vorgehensweise der behandelnden Urologen befindet sich derzeit im Wandel. Obwohl in vielen Fällen sowohl ein konservatives als auch operatives Vorgehen vertreten werden können, scheint sich derzeit eher das konservative Vorgehen durchzusetzen. Dies betrifft auch die höhergradigen Nierenverletzungen (Grade IV und V). Auch bei einer Verletzung des Hohlsystems mit konsekutiver Urinextravasation ist nicht zwingend eine Harnableitung über Harnleitersplintung oder Nephrostomie indiziert, da bis zu 90% dieser Hohlsystemverletzungen spontan sistieren. Des Weiteren ist eine starke Tendenz zum interdisziplinären Vorgehen bei höhergradigen Nierenverletzungen, insbesondere in Zusammenarbeit mit der interventionellen Radiologie, festzustellen. Die Erfolgsraten einer interventionellen Angioembolisation liegen bei 70–80%. Die Entwicklung eines Hypertonus und eine eingeschränkte Nierenfunktion stellen mögliche Langzeitkomplikationen dar. Most renal injuries in industrialized countries are caused by blunt trauma to the kidney. The management of renal trauma has always been and will always be controversial. Conservative management and aggressive intervention both have their proponents, but conservative treatment is generally favored nowadays, even in the case of grade IV/(V) trauma. Urinary diversion by nephrostomy tube or ureteral stenting is not mandatory in most cases because the extravasation resolves in up to 90% of cases. Overall, there is a tendency toward a multimodal approach in which the interventional radiologist is more and more often part of the team that takes care of the patient with high-grade injuries. The success rate of angioembolization is 70–80%. Long-term consequences can be hypertension or diminished kidney function.Der Urologe 01/2008; 47(6):759-768. · 0.46 Impact Factor