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: Although the conservative management of renal trauma has gained in popularity since the middle of the last century, there remains a lack of specific guidance as to what this conservative approach should entail. The literature on the conservative management of renal trauma is reviewed within the framework of the American Association for the Surgery of Trauma (AAST) kidney injury severity scale. The decision on when to initiate conservative management is examined within the modern context of ureteric stenting, percutaneous drainage, and embolisation. Additionally, grade four injuries and intra-operative consults are examined separately in view of the difficulties these groups cause in making appropriate treatment decisions. Graded recommendations are made by a multi-disciplinary panel consisting of urologists, radiologists, and infectious disease physicians. Recommendations are made regarding several key topics including: imaging, inpatient monitoring, thromboprophylaxis, bed rest, antibiotics, discharge criteria, return to activity, and follow-up. These recommendations have undergone formal review and debate at the Western Australian USANZ 2013 state conference, and were presented at the USANZ 2014 annual scientific meeting. It is hoped that these recommendations may help standardise the conservative management of renal trauma, as well as stimulate further debate and research.BJU International 08/2014; 114. DOI:10.1111/bju.12902 · 3.13 Impact Factor
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ABSTRACT: PurposeThe 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.Actas urologicas españolas 09/2009; 33(8):881-887. DOI:10.1016/S0210-4806(09)72876-1 · 1.15 Impact Factor
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