Single shot intraoperative excretory urography for the immediate evaluation of renal trauma
Department of Urology, University of California, School of Medicine, San Francisco General Hospital, 94110, USA. The Journal of Urology
(Impact Factor: 4.47).
05/1999; 161(4):1088-92. DOI: 10.1097/00005392-199904000-00009
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.
Available from: Sean P Elliott
- "The oneshot IVP allows the urologist to stage upper urinary tract injuries and confirm bilateral functioning renal moieties. The one-shot IVP involves a single abdominal film taken on the trauma gurney or the operating table 10 minutes after the injection of a 2 cc/kg bolus of intravenous contrast up to a maximum dosage of 150 cc  "
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ABSTRACT: Both iatrogenic and traumatic ureteral injuries are rare. However, a high index of suspicion is warranted for ureteral injuries because ureteral injuries are associated with increased morbidity. The urologist should be familiar with several methods for identifying ureteral injuries and should make evaluations tailored to the clinical situation. Most ureteral injuries are short transections and can be repaired with debridement and ureteroureterostomy in the proximal and mid-ureter or ureteroneocystostomy in the distal ureter.
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