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Prihadi JC, Hengky A, Lionardi SK. Conservative management in high-grade renal trauma: a systematic review and meta-analysis. BJU Int 2024. [PMID: 38566265 DOI: 10.1111/bju.16343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To systematically investigate and analyse the aggregated data from recent studies to provide a quantitative synthesis for a conservative approach to the management of high-grade kidney trauma, as accumulating evidence supports the favourable outcomes of a conservative approach. METHODS A comprehensive search was performed using databases, including PubMed, EBSCO, ProQuest, Google Scholar, and Cochrane Library, to identify studies relevant to high-grade renal trauma in both adult and paediatric populations. The compare review focused on comparing conservative management interventions, such as observation, rest, resuscitation, transfusion, symptomatic management, and angioembolisation, with operative management interventions. Search strategies incorporated specific medical subject headings and keywords related to conservative management, kidney trauma, mortality, and renal preservation. Random and fixed-effect meta-analyses were conducted to estimate the rates of nephrectomy and mortality, respectively. RESULTS A total of 36 and 29 studies were included for qualitative and quantitative synthesis, respectively. The aggregated data showed a cumulative risk difference of 0.52 (95% confidence interval [CI] 0.38-0.66, P < 0.001), indicating a higher likelihood of nephrectomy in cases where operative management was used instead of conservative management. In terms of mortality, conservative management demonstrated a lower risk difference of 0.09 (95% CI 0.05-0.13, P < 0.001). CONCLUSION The results indicate that opting for conservative management in cases of high-grade renal trauma, particularly for haemodynamically stable patients, presents a lower risk of mortality and reduced probability of requiring nephrectomy when compared to operative management. These findings provide strong evidence in favour of considering conservative management as a viable and effective treatment option for high-grade renal trauma.
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Affiliation(s)
- Johannes Cansius Prihadi
- Division of Urology, Department of Surgery, Atma Jaya Catholic University of Indonesia/Atma Jaya Hospital, Jakarta, Indonesia
| | - Antoninus Hengky
- Center of Health Research, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- Fatima Hospital, Ketapang Regency, Indonesia
| | - Stevan Kristian Lionardi
- School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- Sultan Syarif Mohamad Alkadrie Hospital, Pontianak, Indonesia
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Jastaniah A, Mychaltchouk L, Genest A, Deckelbaum DL, Fata P, Khwaja K, McKendy K, Razek T, Wong E, Grushka J. Repeat imaging increases detection of delayed pseudoaneurysms in patients with high-grade solid organ injury following abdominal trauma. World J Surg 2024; 48:560-567. [PMID: 38501570 DOI: 10.1002/wjs.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND Nonoperative management of abdominal trauma can be complicated by the development of delayed pseudoaneurysms. Early intervention reduces the risk of rupture and decreases mortality. The objective of this study is to determine the utility of repeat computed tomography (CT) imaging in detecting delayed pseudoaneurysms in patients with abdominal solid organ injury. METHODS A retrospective cohort study reviewing Montreal General Hospital registry between 2013 and 2019. Patients with The American Association for the Surgery of Trauma (AAST) grade 3 or higher solid organ injury following abdominal trauma were identified. A chart review was completed, and demographics, mechanism of injury, Injury Severity Score (ISS) score, AAST injury grade, CT imaging reports, and interventions were collected. Descriptive analysis and logistic regression model were completed. RESULTS We identified 195 patients with 214 solid organ injuries. The average age was 38.6 years; 28.2% were female, 90.3% had blunt trauma, and 9.7% had penetrating trauma. The average ISS score was 25.4 (SD 12.8) in patients without pseudoaneurysms and 19.5 (SD 8.6) in those who subsequently developed pseudoaneurysms. The initial management was nonoperative in 57.0% of the patients; 30.4% had initial angioembolization, and 12.6% went to the operating room. Of the cohort, 11.7% had pseudoaneurysms detected on repeat CT imaging within 72 h. Grade 3 represents the majority of the injuries at 68.0%. The majority of these patients underwent angioembolization. CONCLUSIONS In patients with high-grade solid organ injury following abdominal trauma, repeat CT imaging within 72 h enabled the detection of delayed development of pseudoaneurysms in 11.7% of injuries. The majority of the patients were asymptomatic.
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Affiliation(s)
- Atif Jastaniah
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lydia Mychaltchouk
- McGill Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Alexandre Genest
- McGill Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Dan L Deckelbaum
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Paola Fata
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Kosar Khwaja
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Katherine McKendy
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tarek Razek
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Evan Wong
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeremy Grushka
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
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3
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Hakam N, Keihani S, Shaw NM, Abbasi B, Jones CP, Rogers D, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Smith BP, Broghammer JA, Schwartz I, Baradaran N, Zakaluzny SA, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, Myers JB, Breyer BN. Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study. World J Urol 2023; 41:1983-1989. [PMID: 37356027 DOI: 10.1007/s00345-023-04432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/09/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management. METHODS We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery). RESULTS Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25-50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found. CONCLUSION Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group.
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Affiliation(s)
- Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nathan M Shaw
- Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Charles P Jones
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Douglas Rogers
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Sherry S Wang
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Ryan P Joyce
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Judith C Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - J Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel L Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Shubham Gupta
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA
| | - Brian P Smith
- Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ian Schwartz
- Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Nima Baradaran
- Department of Urology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Scott A Zakaluzny
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Brandi D Miller
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | - Reza Askari
- Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Scott Norwood
- Department of Surgery, UT Health Tyler, Tyler, TX, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
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Aziz HA, Bugaev N, Baltazar G, Brown Z, Haines K, Gupta S, Yeung L, Posluszny J, Como J, Freeman J, Kasotakis G. Management of adult renal trauma: a practice management guideline from the eastern association for the surgery of trauma. BMC Surg 2023; 23:22. [PMID: 36707832 PMCID: PMC9881253 DOI: 10.1186/s12893-023-01914-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The kidney is the most frequently injured component of the genitourinary system, accounting for 5% of all trauma cases. Several guidelines by different societies address the management of urological trauma. However, unanswered questions remain regarding optimal use of angioembolization in hemodynamically stable patients, indications for operative exploration of stable retroperitoneal hematomas and renal salvage techniques in the setting of hemodynamic instability, and imaging practices for patients undergoing non-operative management. We performed a systematic review, meta-analysis, and developed evidence-based recommendations to answer these questions in both blunt and penetrating renal trauma. METHODS The working group formulated four population, intervention, comparator, outcome (PICO) questions regarding the following topics: (1) angioembolization (AE) usage in hemodynamically stable patients with evidence of ongoing bleeding; (2) surgical approach to stable zone II hematomas (exploration vs. no exploration) in hemodynamically unstable patients and (3) surgical technique (nephrectomy vs. kidney preservation) for expanding zone II hematomas in hemodynamically unstable patients; (4) frequency of repeat imaging (routine or symptom based) in high-grade traumatic renal injuries. A systematic review and meta-analysis of currently available evidence was performed. RevMan 5 (Cochran Collaboration) and GRADEpro (Grade Working Group) software were used. Recommendations were voted on by working group members and concurrence was obtained for each final recommendation. RESULTS A total of 20 articles were identified and analyzed. Two prospective studies were encountered; the majority were retrospective, single-institution studies. Not all outcomes projected by PICO questions were reported in all studies. Meta-analysis was performed for all PICO questions except PICO 3 secondary to the discrepant patient populations included in those studies. PICO 1 had the greatest number of articles included in the meta-analysis with nine studies; yet, due to differences in study design, no critical outcomes emerged; similar differences among a smaller set of articles prevented observation of critical outcomes for PICO 4. Analyses of PICOs 2 and 3 favored a non-invasive or minimally invasive approach in-line with current international practice trends. CONCLUSION In hemodynamically stable adult patients with clinical or radiographic evidence of ongoing bleeding, no recommendation could be made regarding the role of AE vs. observation. In hemodynamically unstable adult patients, we conditionally recommend no renal exploration vs. renal exploration in stable zone II hematomas. In hemodynamically unstable adult patients, we conditionally recommend kidney preserving techniques vs. nephrectomy in expanding zone II hematomas. No recommendation could be made for the optimal timing of repeat imaging in high grade renal injury. LEVEL OF EVIDENCE Guideline; systematic review, level III.
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Affiliation(s)
- Hiba Abdel Aziz
- grid.260024.20000 0004 0627 4571Midwestern University, Drowners Grove, USA
| | - Nikolay Bugaev
- grid.67033.310000 0000 8934 4045Tufts Medical Center, Boston, USA
| | - Gerard Baltazar
- grid.240324.30000 0001 2109 4251New York University Langone Medical Center, New York, USA
| | - Zachary Brown
- grid.427904.c0000 0001 2315 4051United States Department of Army, Arlington County, USA
| | - Krista Haines
- grid.414179.e0000 0001 2232 0951Duke Medical Center, Durham, USA
| | - Sameer Gupta
- grid.412034.00000 0001 0300 7302Nassau University Medical Center, East Meadow, USA
| | - Lawrence Yeung
- grid.15276.370000 0004 1936 8091University of Florida, Gainesville, USA
| | - Joseph Posluszny
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, USA
| | - John Como
- grid.411931.f0000 0001 0035 4528Metrohealth Medical Center, Cleveland, USA
| | - Jennifer Freeman
- grid.264766.70000 0001 2289 1930Texas Christian University, Fort Worth, USA
| | - George Kasotakis
- grid.412100.60000 0001 0667 3730Duke University Health System, Durham, USA
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Denning Ho R, Shrivastava V, Mokhtari A, Lakshminarayan R. The Role of Renal Artery Embolisation in the Management of Blunt Renal Injuries: A Review. VASCULAR AND ENDOVASCULAR REVIEW 2022. [DOI: 10.15420/ver.2022.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Renal injuries are the most common urinary tract injury secondary to external abdominal trauma. They are caused by blunt, penetrating and iatrogenic mechanisms. Despite the high number of blunt renal injuries, little evidence is available to guide management, especially with the evolution of embolisation as a minimally invasive treatment. Consequently, clinical practice is driven by results of observational studies and anecdote. We have reviewed the current trends in practice when using renal artery embolisation in the management of blunt renal injuries. Three key principles are highlighted. First, high-grade blunt renal injuries can be successfully managed with embolisation. Second, embolisation should be considered when there is radiological evidence of active contrast extravasation, pseudoaneurysm or arteriovenous fistula. Third, embolisation can be used to manage blunt renal injuries in haemodynamically unstable patients. Beyond this, evidence regarding optimal technique, CT indications, clinical status, comorbidities and complications are inconclusive. We discuss the implications for clinical practice and how these findings should define the agenda for future clinical research.
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Wang SL, Agrawal P, Rostom M, Gupta N, Holler A, Pan I, Stevens K, Fang R, Haut E, Fransman R, Berry R, Cohen AJ. Urology Consult Association with Renal Trauma Imaging and Intervention. Urology 2022; 170:209-215. [PMID: 36055419 DOI: 10.1016/j.urology.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To describe rates of urology consultation following renal trauma and assess subsequent impact on imaging and intervention. Renal trauma may be initially managed by either trauma or urologic surgeons alone or collaboratively. Differences in management between the specialties are not well studied. METHODS We conducted an IRB-approved retrospective review of patients at a Level I trauma center sustaining renal trauma between 2014 and 2021. Demographic, injury, radiologic, and intervention variables were extracted. Frequencies and medians were compared using chi-squared and Fischer's exact tests or Mann-Whitney U tests, respectively. Analyses were performed using STATA with p<0.05 considered significant. RESULTS From 2014 to 2021, 118 patients with median age 29 (IQR 22-41) sustained renal trauma. Urology was consulted in 18 (15.3%) cases. Demographic and injury characteristics were similar between the two groups. AAST renal injury grade was transcribed in the initial radiologic reports for 49 (41.5%) of patients. Those in the urology consult group were more likely to receive delayed contrast imaging during their admission (50.0% vs. 17.0%, p<0.01). Among those with high-grade injuries, those with urology consult were less likely to undergo nephrectomy (36.4% vs. 78.8%, p=0.02). CONCLUSIONS We observed differences in imaging patterns between renal trauma patients who are managed primarily by trauma surgery versus urology. However, the impact of these differences in imaging remains to be elucidated. Among patients with high-grade renal trauma, urology consult was associated with decreased rate of nephrectomy, emphasizing the feasibility of renal salvage in a multidisciplinary trauma setting.
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Affiliation(s)
- Shirley L Wang
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Pranjal Agrawal
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Mary Rostom
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Nikita Gupta
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Albert Holler
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Isabelle Pan
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Kent Stevens
- Division of Acute Care Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Raymond Fang
- Division of Acute Care Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Elliott Haut
- Division of Acute Care Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ryan Fransman
- R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Renu Berry
- Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Andrew J Cohen
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland.
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Deininger C, Freude T, Wichlas F, Kriechbaumer LK, Deininger SHM, Törzsök P, Lusuardi L, Pallauf M, Deluca A, Deininger S. On the black slope: analysis of the course of a blunt renal trauma collective in a winter sports region. Eur J Trauma Emerg Surg 2021; 48:2125-2133. [PMID: 34914004 PMCID: PMC9192517 DOI: 10.1007/s00068-021-01830-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
Purpose The aim of this study was to analyze the injury patterns and clinical course of a winter sport dominated by blunt renal trauma collective. Methods Blunt renal trauma cases (N = 106) treated in a Level 1 Trauma Center in Austria were analyzed. Results We encountered 12.3% grade 1, 10.4% grade 2, 32.1% grade 3, 38.7% grade 4 and 6.6% grade 5 renal traumata classified according to the American Association for the Surgery of Trauma (AAST). The mechanisms of injury (MOI) did not have an influence on the frequency of HG trauma (i.e., grade 4 and 5). No concomitant injuries (CIs) were found in 57.9% of patients. The number of patients without CIs was significantly higher in the sports associated trauma group compared to other MOIs (p < 0.01). In 94.3% the primary treatment was a non-operative management (NOM) including 56.6% conservative, 34.0% endourological, and 3.8% interventional therapies. A follow-up computed tomography (FU-CT) was performed in 81.1%, 3.3 days after trauma. After FU-CT, the primary therapy was changed in 11.4% of cases (grade ≥ 3). Comparing the Hb loss between the patients with grade 3 and 4 kidney trauma with and without revision surgery, we find a significantly increased Hb loss within the first 96 h after the trauma in the group with a needed change of therapy (p < 0.0001). The overall rate of nephrectomy (primary or secondary) was 9.4%. Independent predictors of nephrectomy were HG trauma (p < 0.01), age (p < 0.05), and sex (p < 0.05). The probability of nephrectomy was lower with (winter) sports-associated trauma (p < 0.1). Conclusions Sports-associated blunt renal trauma is more likely to occur isolated, and has a lower risk of severe outcomes, compared to other trauma mechanisms. NOM can successfully be performed in over 90% of all trauma grades. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01830-w.
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Affiliation(s)
- Christian Deininger
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria.,Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Freude
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Florian Wichlas
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Konstantin Kriechbaumer
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | | | - Peter Törzsök
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Maximilian Pallauf
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Amelie Deluca
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Susanne Deininger
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria.
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8
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[Renal Parenchyma Trauma and General Trauma Recommandations]. Prog Urol 2021; 31:1001-1013. [PMID: 34814984 DOI: 10.1016/j.purol.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/01/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Among trauma emergencies, kidney damage is uncommon. The urologist is frequently on the second line in the management of patients with multiple traumatic lesions. Knowledge of treatment is necessary to be able to integrate the different teams involved in an approach that is both vital in the context of damage control and functional with a concern for parenchymal preservation. METHODS A systematic review of the literature was carried out using the Medline database in order to identify the most relevant articles in English and French. RESULTS Kidney trauma occurs either by direct shock or by a deceleration mechanism. They are classified by severity according to the AAST classification. Management is mostly conservative by avoiding surgery and controlling bleeding by arterial embolization. Surveillance checks for complications occurrence in high-grade trauma. Traumatic dissection of the renal artery, with a poor functional prognosis requires a short delay before treatment. CONCLUSION The prognosis for trauma to the kidney, regardless of the grade, is currently good, with improvements of effective resuscitation and embolization in the event of bleeding.
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9
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Liguori G, Rebez G, Larcher A, Rizzo M, Cai T, Trombetta C, Salonia A. The role of angioembolization in the management of blunt renal injuries: a systematic review. BMC Urol 2021; 21:104. [PMID: 34362352 PMCID: PMC8344199 DOI: 10.1186/s12894-021-00873-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/20/2021] [Indexed: 12/22/2022] Open
Abstract
Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00873-w.
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Affiliation(s)
- Giovanni Liguori
- Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giacomo Rebez
- Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | | | - Michele Rizzo
- Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, 34149, Trieste, Italy
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10
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Ho P, Hellenthal NJ. Independent predictors of mortality for patients with traumatic renal injury. World J Urol 2021; 39:3685-3690. [PMID: 33398426 DOI: 10.1007/s00345-020-03552-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To investigate the parameters of renal trauma, including emergent intervention type, that predict the mortality of patients with traumatic renal injury. METHODS A retrospective database analysis was performed on patients who sustained a traumatic renal parenchymal injury identified by the 2017 National Trauma Data Bank. Data were analyzed to identify differences in hospital length of stay, ER and hospital disposition, and mortality based on patient age, gender, race, Injury Severity Score, renal injury grade, and need for emergent intervention (angioembolization versus open surgery). Logistic regression was used to correlate intervention type and trauma parameters to mortality. RESULTS A total of 4,876 of 1,004,440 trauma patients (0.49%) had a traumatic renal injury. Of those, 220 (4.5%) underwent an emergent intervention-29 (0.59%) angioembolization and 191 (3.9%) open renal surgery. 83 patients with a blunt renal trauma (2.0%) underwent renal intervention, whereas 136 (21.0%) with a penetrating injury required a procedure. Forty-five of the 220 patients (20.5%) who had a renal intervention died, while 377 of 4,656 (8.1%) who did not have an intervention died. Multiple logistic regression identified black race, age > 45 years, penetrating trauma, and ISS > 15 to be independent predictors of mortality. Neither angioembolization nor open renal surgery was associated with a significantly higher likelihood of mortality in the multivariable model. CONCLUSION While procedural interventions are associated with higher mortality for patients with traumatic renal injury, other factors, such as race, age, trauma type, and injury severity may be more predictive of death under care.
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Affiliation(s)
- Patrick Ho
- Columbia-Bassett Program, Bassett Healthcare, Cooperstown, NY, USA.
| | - Nicholas J Hellenthal
- Division of Urology, Department of Surgery, Bassett Healthcare, Cooperstown, NY, USA
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11
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Loftus CJ, Hagedorn JC, Johnsen NV. Does routine repeat imaging for blunt high-grade renal trauma lead to unnecessary interventions? J Trauma Acute Care Surg 2021; 90:143-147. [PMID: 33009338 DOI: 10.1097/ta.0000000000002966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most high-grade renal injuries with urinary extravasation (UE) may be managed conservatively without intervention. For such patients, the American Urological Association Urotrauma guidelines recommend repeat imaging within 48 to 72 hours of injury. We sought to examine whether routine, proactive follow-up renal imaging was associated with need for urologic intervention or risk of complications. METHODS Patients treated to an urban level 1 trauma center for a five-state region, between 2005 and 2017 were identified by International Classification of Diseases, Ninth Revision and Tenth Revision, codes from a prospectively collected institutional trauma registry. Individual patient charts and imaging were reviewed to identify all patients with American Association for the Surgery of Trauma grade IV renal injuries. Those with UE were included, and patients with penetrating trauma, immediate urologic surgery, or in-hospital mortality were excluded. RESULTS Of 342 patients with grade IV injuries, 108 (32%) met the inclusion criteria. Urologic intervention was performed in 23% (25 of 108 patients) including endoscopic procedure (24 of 108 patients) and nephrectomy (1 of 108 patients). Repeat imaging was performed within 48 to 72 hours after initial imaging in 65% (70 to 108 patients). Patients who underwent routine reimaging had a higher rate of undergoing subsequent urologic procedure (31.4% vs. 7.1%, p = 0.008). For patients with reimaging who underwent a procedure, 18% (4 of 22 patients) were symptomatic, while all nonroutinely reimaged patients who underwent a procedure were symptomatic (3 of 3 patients). Patients who received routine repeat imaging had a higher mean number of abdominal computed tomography scans during their admission (2.5 vs. 1.7, p < 0.001), while the complication rate was similar between groups. CONCLUSIONS Patients with grade IV renal lacerations with UE from blunt trauma who received routine repeat imaging were more likely to undergo an operation in the absence of symptoms and received more radiation during their hospital stay. Forgoing repeat imaging was not associated with an increase in urological complications. These data suggest that, in the absence of signs/symptoms, repeat imaging may be avoidable. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
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Affiliation(s)
- Christopher J Loftus
- From the Department of Urology (C.J.L., J.C.H.), University of Washington Medical Center, Seattle, Washington; and Department of Urology (N.V.J.), Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Birgi E, Durmaz H, Güreşci K, Ergun O, Çığsar G, Kurtuluş B, Hekimoğlu B. Endovascular management of traumatic arterial emergencies: A single center retrospective study. JOURNAL OF ACUTE DISEASE 2021. [DOI: 10.4103/2221-6189.330741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Choudhury S, Ray P, Pal DK. Changing paradigms of management of isolated blunt renal trauma. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620965446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The last thirty years has seen a change in management of renal trauma with progression more towards nonoperative management; however there is lack of guidelines of many practical aspects for conservative management of renal trauma. Here we are sharing our experience of managing isolated renal trauma over a period of five years. Materials and methods The study was conducted in a tertiary care centre of eastern part of India from April 2015–March 2020. It was a retro-prospective study and included cases of isolated blunt renal trauma managed in our hospital. Results A total of 61 cases of isolated blunt renal trauma were treated in the mentioned time period. Seventeen (28%) cases were of AAST Grade IV and five (8%) Grade V injury. Blood transfusion was required in eighteen (29%) cases during management. In eight (47%) cases of Grade IV injury and two (40%) cases of Grade V injury angioembolization was done. In two (11.7%) cases of Grade IV injury ureteral stenting was performed. Delayed surgical exploration and nephrectomy was required in one case of Grade V injury because of failed angioembolization and one Grade IV injury due to sepsis. One death was encountered in Grade V injury who had delayed presentation with haemorrhagic shock and underwent immediate surgical exploration. On follow up four patients (23%) of Grade IV injury and one patient of Grade III injury and two patients (40%) of Grade IV injury developed hypertension. The remaining patients were found to be normal. Conclusion Conservative management of renal trauma is the norm nowadays. Angioembolisation was found to be one of the strongest armamentarium when patient needs intervention. Surgery is rarely contemplated, mostly in hemodynamically unstable high grade trauma patients.
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Affiliation(s)
- Sunirmal Choudhury
- Department of Urology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Pinaki Ray
- Department of Urology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education & Research, Kolkata, India
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14
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Traumatic renal artery dissection: from imaging to management. Clin Radiol 2020; 76:153.e17-153.e24. [PMID: 32993880 DOI: 10.1016/j.crad.2020.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022]
Abstract
Injury to the renal artery following blunt trauma is detected increasingly due to widespread and early use of multidetector computed tomography (CT), but optimal treatment remains controversial as no guidelines are available. This review illustrates the spectrum of imaging findings of traumatic renal artery dissection based on our experience, with the aim of understanding the physiopathology of ischaemic damage to the kidney, and the process of choosing the best therapeutic strategy (conservative, endovascular, surgical). Five main patterns of traumatic renal artery dissection are described: avulsion of renal hilum; dissection of the segmental renal branches; preocclusive main renal artery dissection; renal artery stenosis without flow limitation; thrombogenic renal artery intimal tear. In the polytrauma patient, management depends on various factors (haemodynamic status, associated lesions, time of diagnosis) rather than on the degree of renal artery stenosis. Non-operative management (NOM) is the preferred option in case of non-flow-limiting dissection of the renal artery and angio-embolisation is an important adjunct to NOM in cases of active bleeding. Embolisation of the renal artery stump may be the best option in cases of occlusive dissection, as catheter manipulation carries a high risk of vessel rupture. The therapeutic window for kidney revascularisation in cases of flow-limiting dissection of main renal artery may be variable. Endovascular stenting >4 h after trauma should be performed only if residual flow with preserved parenchymal perfusion is detected at angiography. Antiplatelet therapy administration is recommended in cases of stenting, but conditioned by the bleeding risk of the patient.
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15
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Chebbi A, Peyronnet B, Giwerc A, Freton L, Hutin M, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Matillon X, Caes T, Patard PM, Szabla N, Brichart N, Boehm A, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec FX, Rod X, Fiard G, Pradere B, Pfister C, Nouhaud FX. Observation vs. early drainage for grade IV blunt renal trauma: a multicenter study. World J Urol 2020; 39:963-969. [PMID: 32447442 DOI: 10.1007/s00345-020-03255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/11/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The aim of this study was to compare observation and early drainage by ureteral stenting in patients with blunt renal trauma and urinary extravasation. MATERIALS AND METHODS A retrospective national multicenter study was performed including all patients admitted for renal trauma at 17 hospitals between 2005 and 2015. Patients presenting with a urinary extravasation on initial imaging were considered for inclusion. Patients were divided in two groups according to the initial approach: observation vs. early drainage by ureteral stent (within 48 h after admission). The primary endpoint was the persistence of urinary extravasation on follow-up imaging. RESULTS Out of 1799 patients with renal trauma, 238 were included in the analysis (57 in the early drainage and 181 in the observation group). In the early drainage group, 29 patients had persistent urinary extravasation vs. 77 in the observation group (50.9% vs. 42.5%; p value = 0.27). The rates of secondary upper urinary tract drainage did not differ significantly between the early drainage group (26.4%) and the observation group (16%) (p = 0.14). There were no statistically significant differences between the two groups in terms of secondary nephrectomy (0% vs. 2.8%; p = 0.34), and death from trauma (0% vs. 1.8%; p = 0.99). In multivariate analysis, early drainage remained not statistically associated with persistence of urinary extravasation on follow-up imaging (OR = 1.35; p = 0.36) CONCLUSION: In this multicenter cohort, observation was not different from early drainage in terms of persistent urinary extravasation after grade IV blunt renal trauma. Further randomized controlled prospective trials are needed to confirm these findings.
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Affiliation(s)
- Ala Chebbi
- Urology, University of Rouen, Rouen, France.
- Service d'urologie, Hopital Charles Nicolle, 37 boulevard Gambetta, 76000, Rouen, France.
| | | | | | | | - Marine Hutin
- Urology, University of Montpellier, Montpellier, France
| | | | | | - Marina Ruggiero
- Urology, University of Paris Sud, CHU Bicetre, Paris, France
| | | | | | | | | | - Reem Betari
- Urology, University of Amiens, Amiens, France
| | | | | | | | | | | | | | - Laura Sabourin
- Urology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Cédric Lebacle
- Urology, University of Paris Sud, CHU Bicetre, Paris, France
| | | | | | | | - Xavier Rod
- Urology, University of Nantes, Nantes, France
| | - Gaelle Fiard
- Urology, University of Grenoble, Grenoble, France
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16
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Hamid S, Nicolaou S, Khosa F, Andrews G, Murray N, Abdellatif W, Qamar SR. Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen. Can Assoc Radiol J 2020; 71:371-387. [DOI: 10.1177/0846537120905301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.
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Affiliation(s)
- Saira Hamid
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faisal Khosa
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordon Andrews
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Murray
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Waleed Abdellatif
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sadia Raheez Qamar
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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17
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El Hechi MW, Nederpelt C, Kongkaewpaisan N, Bonde A, Kokoroskos N, Breen K, Nasser A, Saillant NN, Kaafarani HMA, Velmahos GC, Mendoza AE. Contemporary management of penetrating renal trauma - A national analysis. Injury 2020; 51:32-38. [PMID: 31540800 DOI: 10.1016/j.injury.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Indications for nonoperative management (NOM) after penetrating renal injury remain ill-defined. Using a national database, we sought to describe the experience of operative and nonoperative management in the United States and retrospectively examine risk factors for failure of NOM. MATERIALS AND METHODS The TQIP database 2010-2016 was used to identify patients with penetrating renal trauma. Outcomes of patients treated with an immediate operation (IO) and NOM are described. Failure of NOM was defined as the need for a renal operation after 4 h from arrival. Univariate then multivariable regression analyses were performed to identify predictors of NOM failure. RESULTS Out of 8139 patients with kidney trauma, 1,842 had a penetrating mechanism of injury and were included. Of those, 89% were male, median age was 28 years, and 330 (18%) were offered NOM. Compared to IO, NOM patients were less likely to have gunshot wound (59% vs 89% p < 0.001) or high-grade renal injuries [AAST 4-5] (48% vs 76%, p < 0.001). Lower rates of in-hospital complications and shorter ICU and hospital stays were observed in the NOM group. NOM failed in 26 patients (8%). Independent predictors of NOM failure included a concomitant abdominal injury (OR = 3.99, 95% CI 1.03-23.23, p = 0.044), and every point increase in AAST grade (OR = 2.43, 95% CI 1.27-5.21, p = 0.005). CONCLUSIONS NOM is highly successful in selected patients. Concomitant abdominal injuries and higher grade AAST injuries predict NOM failure and should be considered when selecting patients for IO or NOM.
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Affiliation(s)
- Majed W El Hechi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Charlie Nederpelt
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Alexander Bonde
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Nikolaos Kokoroskos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Kerry Breen
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Ahmed Nasser
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Noelle N Saillant
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - George C Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - April E Mendoza
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
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18
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Petrone P, Perez-Calvo J, Brathwaite CEM, Islam S, Joseph DK. Traumatic kidney injuries: A systematic review and meta-analysis. Int J Surg 2019; 74:13-21. [PMID: 31870753 DOI: 10.1016/j.ijsu.2019.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/19/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Traumatic kidney injury is an infrequent event with a wide range of injury patterns. The aim of this paper is to review the incidence, mechanisms of injury, diagnostic methods, and therapeutic indications of renal injury according to the most recent evidence and to perform an analysis of mortality rates on these patients. OBJECTIVES To perform a systematic review of the literature and a meta-analysis on traumatic kidney injuries. DATA SOURCES A literature search was performed using PubMed, Embase, and Scopus databases. Articles published in English, French and Spanish were selected from 1963 to 2018. MeSH terms utilized were renal trauma, kidney trauma, blunt renal trauma, and penetrating renal trauma. STUDY PARTICIPANTS The eligibility criteria included only original and human subject articles. Articles not involving human patients, cancer related, review articles, surveys, iatrogenic injuries, pediatric patients, and case reports were excluded from this search. RESULTS Forty-six articles met the inclusion criteria of which 48,660 patients were identified and included in this review. Gender was reported in 32,918 cases, of which 75.3% of patients were male with a mean age of 33 years. Of the 44,865 patients where the mechanism of injury was described, we identified 36,086 (80.5%) patients that sustained blunt trauma, while 8,779 (19.5%) were due to penetrating mechanisms. Twenty one series with a total of 31,689 patients included the mortality rate. Overall mortality rate with exact binomial 95% confidence interval estimated via random effects model was 6.4% (4.8%-8.4%). CONCLUSIONS Non-operative management has become the standard in renal trauma management with good results in morbidity and mortality. This has resulted in a decrease in the number of unnecessary iatrogenic nephrectomies and potential improvement in a patient's quality of life. When an invasive treatment is necessary, angioembolization for active bleeding or nephrorrhaphy is usually sufficient.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, NY, USA.
| | - Javier Perez-Calvo
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Collin E M Brathwaite
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Shahidul Islam
- Department of Biostatistics, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, NY, USA
| | - D'Andrea K Joseph
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, NY, USA
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Khoschnau S, Jabbour G, Al-Hassani A, El-Menyar A, Abdelrahman H, Afifi I, Momin UZ, Peralta R, Al-Thani H. Traumatic Kidney Injury: An Observational Descriptive Study. Urol Int 2019; 104:148-155. [PMID: 31846981 DOI: 10.1159/000504895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trauma is a major cause of death and disability worldwide. Renal injuries account for 8-10% of abdominal trauma. We aimed to describe the incidence, presentation, and management of traumatic kidney injury in our institution. METHODS This is a retrospective analysis of all patients admitted with traumatic kidney injury at a level 1 trauma center between January 2014 and December 2017. RESULTS During a period of 3 years, a total of 152 patients with blunt renal trauma were admitted to a level 1 trauma center; 91% of these were males, with a mean age of 32.8 ± 13.7 years. Motor vehicle crashes accounted for 68% of cases, followed by fall from height (23%). Seventy-one percent of patients had associated chest injuries, 38% had pelvis injuries, and 32% had head injury. Associated abdominal injuries included the liver (35%) and spleen (26%). The mean abdominal abbreviated injury scale was 2.8 ± 1.0; and for those with severe renal injury, it was 3.9 ± 0.9. The mean injury severity score was 24.9 ± 13.7 (31.8 ± 14.2 with renal vs. 21.9 ± 12.9 without renal injury, p = 0.004). Most of the patients were treated conservatively (93%), including severe renal injuries (grades IV and V), and 7% had surgical exploration, mainly those with severe injuries (grades IV and V). The mortality rate was 11%. CONCLUSIONS High-grade renal injuries in hemodynamically stable patients can be managed conservatively. A multidisciplinary approach coordinated by trauma, urology, and radiology services facilitates the care of these patients in our trauma center.
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Affiliation(s)
| | - Gaby Jabbour
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ammar Al-Hassani
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery Section, Hamad General Hospital (HGH), Doha, Qatar, .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar,
| | | | - Ibrahim Afifi
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Umais Ziad Momin
- Department of Radiology, Hamad General Hospital (HGH), Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
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20
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Aldiwani M, Georgiades F, Omar I, Angel-Scott H, Tharakan T, Vale J, Mayer E. Traumatic renal injury in a UK major trauma centre - current management strategies and the role of early re-imaging. BJU Int 2019; 124:672-678. [PMID: 30903729 DOI: 10.1111/bju.14752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To analyse the contemporary management of renal injuries in a UK major trauma centre and to evaluate the utility and value of re-imaging. PATIENTS AND METHODS The prospectively maintained 'Trauma Audit and Research Network' database was interrogated to identify patients with urinary tract injuries between January 2014 and December 2017. Patients' records and imaging were reviewed to identify injury grades, interventions, outcomes, and follow-up. RESULTS Renal injury was identified in 90 patients (79 males and 11 females). The mean (sd; range) age was 35.5 (17.4; 1.5-94) years. Most of the renal traumas were caused by blunt mechanisms (74%). The overall severity of injuries was: 18 (20%) Grade I, 19 (21%) Grade II, 27 (30%) Grade III, 22 (24%) Grade IV, and four (4%) Grade V. Most patients (84%) were managed conservatively. Early intervention (<24 h) was performed in 14 patients (16%) for renal injuries. Most of these patients were managed by interventional radiology techniques (nine of 14). Only two patients required an emergency nephrectomy, both of whom died from extensive polytrauma. In all, 19 patients underwent laparotomy for other injuries and did not require renal exploration. The overall 30-day mortality was 13%. Re-imaging was performed in 66% of patients at an average time of 3.4 days from initial scan. The majority of re-imaging was planned (49 patients) and 12% of these scans demonstrated a relevant finding (urinoma, pseudoaneurysm) that altered management in three of the 49 patients (6.1%). CONCLUSION Non-operative management is the mainstay for all grades of injury. Haemodynamic instability and persistent urine leak are primary indications for intervention. Open surgical management is uncommon. Repeat imaging after injury is advocated for stable patients with high-grade renal injuries (Grade III-V), although more research is needed to determine the optimal timing.
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Affiliation(s)
- Mohammed Aldiwani
- Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Fanourios Georgiades
- Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Ismail Omar
- Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Helena Angel-Scott
- Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Tharu Tharakan
- Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Justin Vale
- Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Erik Mayer
- Department of Urology, St Mary's Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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21
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Moses RA, Anderson RE, Keihani S, Hotaling JM, Nirula R, Vargo DJ, Myers JB. High grade renal trauma management: a survey of practice patterns and the perceived need for a prospective management trial. Transl Androl Urol 2019; 8:297-306. [PMID: 31555553 DOI: 10.21037/tau.2019.07.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To evaluate the current practice patterns of practitioners managing high grade renal trauma and determine perceived need for a prospective trial on the management of renal trauma. Methods We distributed an electronic survey to members of the American Association for the Surgery of Trauma (AAST) and The Society of Genitourinary Reconstructive Surgeons (GURS). The survey evaluated demographics, interventional radiology (IR) access, and renal trauma management. Descriptive statistics were utilized to analyze participants' responses. Results A total of 253 practitioners responded (age 48.4±10.4 years). The majority were acute care/trauma surgeons (ACS/TS) (63.2%), followed by urologists (34.4%) practicing at level 1 trauma centers (80.6%) in 39 US states. Most participants were in practice >10 years (62.8%); and had completed an ACS/TS (53.8%), or trauma/reconstructive urology (25.7%) fellowship. Ninety-five percent (241/253) found value in renal preservation with 74% utilizing IR embolization in the last year. However, there was wide variation in threshold for angiography, low rates of renal repair (24%) or packing (20%) and half reported performing a nephrectomy within the prior year. More than 80% believed there was value in a prospective trial to evaluate a protocol to decrease nephrectomy rates in renal trauma management. Conclusions The majority of respondents had access to IR, reported comfort in renorrhaphy, and valued renal preservation. There was variation in thresholds for bleeding intervention, and nephrectomy was still a common management strategy. There is great interest among trauma surgeons and urologists for a prospective trial of renal trauma management aimed at decreasing nephrectomy when possible.
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Affiliation(s)
- Rachel A Moses
- Section of Urology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Ross E Anderson
- Division of Urology, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Sorena Keihani
- Division of Urology, University of Utah Medical Center, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Raminder Nirula
- Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Daniel J Vargo
- Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Division of Urology, University of Utah Medical Center, Salt Lake City, UT, USA
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22
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Chien LC, Vakil M, Nguyen J, Chahine A, Archer-Arroyo K, Hanna TN, Herr KD. The American Association for the Surgery of Trauma Organ Injury Scale 2018 update for computed tomography-based grading of renal trauma: a primer for the emergency radiologist. Emerg Radiol 2019; 27:63-73. [PMID: 31489487 DOI: 10.1007/s10140-019-01721-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022]
Abstract
The most widely used trauma injury grading system is the Organ Injury Scale (OIS) by the American Association for the Surgery of Trauma (AAST). The AAST OIS for renal trauma was revised in 2018 to reflect necessary updates based on decades of experience with computed tomography (CT)-based injury diagnosis and, specifically, to better incorporate vascular injuries, which were not comprehensively addressed in the original OIS. In this review article, we describe CT findings of the AAST OIS for the kidney according to the 2018 revision, with an emphasis on real-world application, and highlight important differences from the prior grading scheme. Routine use of this grading system allows for a standardized classification of the range of renal injuries to aid in management, adding value in the imaging care of trauma patients.
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Affiliation(s)
- Ling-Chen Chien
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Mona Vakil
- Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30308, USA
| | - Jonathan Nguyen
- Grady Memorial Hospital, Department of Surgery, Division of Trauma and Critical Care, Morehouse School of Medicine, Atlanta, GA, 30303, USA
| | - Amanda Chahine
- Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30308, USA
| | - Krystal Archer-Arroyo
- Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30308, USA
| | - Tarek N Hanna
- Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30308, USA
| | - Keith D Herr
- Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30308, USA
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Latabi AF, Aitzirri K, Moudouni SM, Lakmichi MA, Dahami Z, Sarf I. [Factors predicting of failure after conservative treatment in III-V grade renal trauma]. Prog Urol 2019; 29:416-422. [PMID: 31230856 DOI: 10.1016/j.purol.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/13/2019] [Accepted: 05/18/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Surgical exploration of renal injury secondary to major trauma often leads to nephrectomy. The aim of this work was to identify the factors associated with the need for surgery in patients with III-V grade renal trauma who were initially managed conservatively. MATERIALS AND METHODS We retrospectively reviewed data from patients with Grade III-V kidney injury between June 2005 and June 2015. Demographic, clinical and bio-radiological characteristics at admission and follow-up, as well as management and complications, were recorded. Patient data, including conservative treatment, was a success without recourse to nephrectomy, and those patients who needed surgery were analyzed. RESULTS Seventy three patients were included in this study. Grade III accounted for 45%, Grade IV: 49% and Grade V: 5%. The success rate for conservative treatment was 79%: 31 patients grade III (94%), 26 grade IV (72%) and no grade V patients. hypotension at admission (P=0.04), hematoma size greater than 3.5 centimeters (P=0.002), grade V (P=0.003), anemia (P=0.04), blood transfusion (P=0.01) and worsening of lesions of the control CT lesions (P=0.001), are the factors considered as predictive of failure of conservative treatment. CONCLUSION Conservative management is the treatment of choice in III-V grade renal trauma, and the prognostic factors found in this study make it possible to better select patients. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A F Latabi
- Centre hospitalier universitaire de Marrakech, Maroc.
| | - K Aitzirri
- Centre hospitalier universitaire de Marrakech, Maroc
| | - S M Moudouni
- Centre hospitalier universitaire de Marrakech, Maroc
| | - M A Lakmichi
- Centre hospitalier universitaire de Marrakech, Maroc
| | - Z Dahami
- Centre hospitalier universitaire de Marrakech, Maroc
| | - I Sarf
- Centre hospitalier universitaire de Marrakech, Maroc
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24
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Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference. J Trauma Acute Care Surg 2019; 84:517-531. [PMID: 29261593 DOI: 10.1097/ta.0000000000001774] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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25
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Sujenthiran A, Elshout PJ, Veskimae E, MacLennan S, Yuan Y, Serafetinidis E, Sharma DM, Kitrey ND, Djakovic N, Lumen N, Kuehhas FE, Summerton DJ. Is Nonoperative Management the Best First-line Option for High-grade Renal trauma? A Systematic Review. Eur Urol Focus 2019; 5:290-300. [DOI: 10.1016/j.euf.2017.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/10/2017] [Accepted: 04/29/2017] [Indexed: 10/19/2022]
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26
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Mann U, Zemp L, Rourke KF. Contemporary management of renal trauma in Canada: A 10-year experience at a level 1 trauma centre. Can Urol Assoc J 2018; 13:E177-E182. [PMID: 30407154 DOI: 10.5489/cuaj.5581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Contemporary Canadian renal trauma data is lacking. Our objective is to describe 10-year outcomes of renal trauma at a Canadian level 1 trauma centre using a conservative approach. METHODS The Alberta Trauma Registry at the University of Alberta was used to identify renal trauma patients from October 2004 to December 2014. Hospital records and imaging were reviewed to identify clinic-radiographical factors, including patient age, gender, Injury Severity Score (ISS), American Association of the Surgery for Trauma (AAST) grade, computerized tomography (CT) findings, urological interventions, length of stay, transfusion and death rates. Descriptive statistics, Chi-square, and t-tests were used when appropriate. RESULTS A total of 368 renal trauma patients were identified. Mechanism of injury was blunt trauma in 89.1% of cases, mean age was 36.2 years, and mean ISS was 30.8 (±13.6). AAST grade distribution was 16.6% (Grade 1), 22.8% (Grade 2), 36.4% (Grade 3), 20.9% (Grade 4), and 3.3% (Grade 5). Overall, 9.5% (35) of patients required urological intervention for a total of 40 treatments, including ureteral stenting (3.0%), angioembolization (3.3%), percutaneous drainage (0.3%), or open intervention including nephrectomy (2.4%) and renorrhaphy (0.5%). No Grade 1 or 2 injuries required intervention, while 1.5%, 31.2%, and 75.0% of Grade 3, 4, and 5 injuries did, respectively. The overall renal salvage rate was 97.6%, which did not differ by mechanism of injury (p=0.25). Patients with penetrating trauma were more likely to require urological intervention (20.0% vs. 8.2%; p=0.04). Of the high-grade (III-V) renal injuries identified, 15.7% (35/223) required urological intervention, 4.9% (11) required open surgical intervention, and only 4.0% (9) of patients with high-grade renal injury required nephrectomy. CONCLUSIONS The trend towards conservative treatment of renal trauma in Canada appears well-supported even in a severely injured patient population, as over 90% of patients avoid urological intervention and only 3% require operative intervention resulting in renal salvage rates of 97.6%.
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Affiliation(s)
- Uday Mann
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Logan Zemp
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, University of Alberta, Edmonton, AB, Canada
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Does routine repeat imaging change management in high-grade renal trauma? Results from three level 1 trauma centers. World J Urol 2018; 37:1455-1459. [PMID: 30276541 DOI: 10.1007/s00345-018-2513-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Guidelines call for routine reimaging of Grade 4-5 renal injuries at 48-72 h. The aim of the current study is to evaluate the clinical utility of computed tomography (CT) reimaging in high-grade renal injuries. MATERIALS AND METHODS We assembled data on 216 trauma patients with high-grade renal trauma at three level 1 trauma centers over a 19-year span between 1999 and 2017 in retrospectively collected trauma database. Demographic, radiographic, and clinical characteristics of patients were retrospectively reviewed. RESULTS In total, 151 cases were Grade 4 renal injuries, and 65 were Grade 5 renal injuries. 53.6% (81) Grade 4 and 15.4% (10) Grade 5 renal injuries were initially managed conservatively. Of the 6 asymptomatic cases where repeat imaging resulted in intervention, 100% had collecting system injuries at initial imaging. Collecting system injuries were only present in 42.9% of cases where routine repeat imaging did not trigger surgical intervention. Collecting system injury at the time of initial imaging was a statistically significant predictor of routine repeat imaging triggering surgical intervention (p = 0.022). Trauma grade and the presence of vascular injury were not significant predictors of intervention after repeat imaging in asymptomatic patients. CONCLUSION In asymptomatic patients with high-grade renal trauma, the number needed to image is approximately one in eight (12.5%) to identify need for surgical intervention. There is potentially room to improve criteria for routine renal imaging in high-grade renal trauma based on the more predictive imaging finding of collecting system injury.
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Erlich T, Kitrey ND. Renal trauma: the current best practice. Ther Adv Urol 2018; 10:295-303. [PMID: 30186367 DOI: 10.1177/1756287218785828] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 06/07/2018] [Indexed: 11/15/2022] Open
Abstract
The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion's share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.
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Affiliation(s)
- Tomer Erlich
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Noam D Kitrey
- Department of Urology, The Chaim Sheba Medical Center, 2 Sheba Road, Tel Hashomer, 5262100, Israel
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29
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Wortman JR, Uyeda JW, Fulwadhva UP, Sodickson AD. Dual-Energy CT for Abdominal and Pelvic Trauma. Radiographics 2018. [DOI: 10.1148/rg.2018170058] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jeremy R. Wortman
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Jennifer W. Uyeda
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Urvi P. Fulwadhva
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Aaron D. Sodickson
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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30
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Joseph DK, Daman D, Kinler RL, Burns K, Jacobs L. Management of Major Blunt Renal Injury: A Twelve-Year Review at an Urban, Level I Trauma Hospital. Am Surg 2018. [DOI: 10.1177/000313481808400333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the management of severe blunt renal injuries at a Level I trauma hospital. Data were collected through a record review of patients admitted from January 1, 2000, to December 31, 2011. These data were compiled as part of our hospital's participation in the Nonoperative Management of Grade IV and V Blunt Renal Injuries: A Research Consortium of New England Centers for Trauma Study. Thirty-six patients with severe blunt renal injuries were identified. Twenty-nine (80.6%) underwent nonoperative management (NOM) for their injuries. Seven (19.4%) received an immediate operation because of hemodynamic instability or CT findings of large hemoperitoneum or extravasation. No significant differences were observed on Injury Severity Score, Glasgow Coma Scale, injury grade, or systolic blood pressure on arrival to the emergency department. On arrival, the operative patients had higher heart rates and lower hematocrit and hemoglobin values relative to the NOM patients. The kidney was salvaged in three of the seven operative patients and was either saved or partially saved in all except one NOM patient. Three NOM patients died; none because of renal injuries. All other patients were successfully managed. None of the operative patients died. NOM management of high-grade renal injury was successful for these patients and should be considered in the management of grade IV and V blunt renal trauma.
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Affiliation(s)
| | - Daniel Daman
- Department of Surgery, University of Connecticut, Farmington Connecticut
- Hartford Hospital, Hartford HealthCare Research Institute, Hartford, Connecticut
| | - Rae Lynne Kinler
- Hartford Hospital, Hartford HealthCare Research Institute, Hartford, Connecticut
| | - Karyl Burns
- Department of Surgery, University of Connecticut, Farmington Connecticut
- Hartford Hospital, Hartford HealthCare Research Institute, Hartford, Connecticut
| | - Lenworth Jacobs
- Department of Surgery, University of Connecticut, Farmington Connecticut
- Hartford Hospital, Hartford HealthCare Research Institute, Hartford, Connecticut
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31
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Early identification of patients requiring massive transfusion, embolization or hemostatic surgery for traumatic hemorrhage: A systematic review and meta-analysis. J Trauma Acute Care Surg 2018; 84:505-516. [DOI: 10.1097/ta.0000000000001760] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Phan QB, Mourey E, Estivalet L, Delattre B, Bardet F, Chevallier O, Louis D, Aho L, Loffroy R, Cormier L. Reliability and reproducibility of the American Association for the Surgery of Trauma scaling for renal injury and impact on radiologic follow-up. Prog Urol 2018; 28:12-17. [DOI: 10.1016/j.purol.2017.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/12/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
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33
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Mingoli A, La Torre M, Migliori E, Cirillo B, Zambon M, Sapienza P, Brachini G. Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis. Ther Clin Risk Manag 2017; 13:1127-1138. [PMID: 28894376 PMCID: PMC5584778 DOI: 10.2147/tcrm.s139194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Preservation of kidney and renal function is the goal of nonoperative management (NOM) of renal trauma (RT). The advantages of NOM for minor blunt RT have already been clearly described, but its value for major blunt and penetrating RT is still under debate. We present a systematic review and meta-analysis on NOM for RT, which was compared with the operative management (OM) with respect to mortality, morbidity, and length of hospital stay (LOS). Methods The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed for this study. A systematic search was performed on Embase, Medline, Cochrane, and PubMed for studies published up to December 2015, without language restrictions, which compared NOM versus OM for renal injuries. Results Twenty nonrandomized retrospective cohort studies comprising 13,824 patients with blunt (2,998) or penetrating (10,826) RT were identified. When all RT were considered (American Association for the Surgery of Trauma grades 1–5), NOM was associated with lower mortality and morbidity rates compared to OM (8.3% vs 17.1%, odds ratio [OR] 0.471; 95% confidence interval [CI] 0.404–0.548; P<0.001 and 2% vs 53.3%, OR 0.0484; 95% CI 0.0279–0.0839, P<0.001). Likewise, NOM represented the gold standard treatment resulting in a lower mortality rate compared to OM even when only high-grade RT was considered (9.1% vs 17.9%, OR 0.332; 95% CI 0.155–0.708; P=0.004), be they blunt (4.1% vs 8.1%, OR 0.275; 95% CI 0.0957–0.788; P=0.016) or penetrating (9.1% vs 18.1%, OR 0.468; 95% CI 0.398–0.0552; P<0.001). Conclusion Our meta-analysis demonstrated that NOM for RT is the treatment of choice not only for AAST grades 1 and 2, but also for higher grade blunt and penetrating RT.
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Affiliation(s)
- Andrea Mingoli
- Emergency Department.,Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Marco La Torre
- Emergency Department.,Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Emanuele Migliori
- Emergency Department.,Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Bruno Cirillo
- Emergency Department.,Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Martina Zambon
- Emergency Department.,Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Paolo Sapienza
- Emergency Department.,Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Gioia Brachini
- Emergency Department.,Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy
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Successful Nonoperative Management of High-Grade Blunt Renal Injuries. Adv Urol 2016; 2016:3568076. [PMID: 28018427 PMCID: PMC5149603 DOI: 10.1155/2016/3568076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/19/2016] [Accepted: 10/24/2016] [Indexed: 11/17/2022] Open
Abstract
Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM (P = 0.01). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) (P = 0.01). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management.
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35
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Affiliation(s)
- A N Smolyar
- N.V. Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
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36
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Abstract
Introduction Nonoperative and minimally invasive management techniques for both blunt and penetrating renal trauma have become standard of care over the past decades. We sought to examine the modern epidemiology of renal trauma over the past decade. Methods A systematic review of PubMed from the past decade was conducted to examine adult and pediatric renal trauma. A total of 605 articles were identified. Of these, 15 adult and 5 pediatric articles met our a priori search criteria. Results There is a lack of uniform reporting of the renal trauma demographics precluding accurate assessment. Despite this, we were able to elucidate the following details. Renal trauma predominately affects young adult males, and the etiology is predominantly blunt. Among blunt injuries, motor vehicle crashes are most common among adult and pediatric patients. Nonoperative care was utilized in 94.8% of reviewed manuscripts with a 5.4% nephrectomy rate. Discussion There do not appear to be any startling changes in the presentation of adult and pediatric renal trauma over the past decade. Nonoperative care continues to be utilized as primary therapy. Increased attention on the reporting of renal trauma demographics is necessary to improve detection of trends. Conclusions Increased reporting of the presenting demographics of adult and pediatric renal trauma is encouraged to assist future assessment of epidemiology.
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Affiliation(s)
- Bryan B Voelzke
- Department of Urology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington 98104, USA
| | - Laura Leddy
- Department of Urology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington 98104, USA
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Dangle PP, Fuller TW, Gaines B, Cannon GM, Schneck FX, Stephany HA, Ost MC. Evolving Mechanisms of Injury and Management of Pediatric Blunt Renal Trauma--20 Years of Experience. Urology 2016; 90:159-63. [PMID: 26825488 DOI: 10.1016/j.urology.2016.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review 20 years of a prospectively maintained trauma database to identify changing trends in mechanisms of renal injury, demographics, and management outcomes. MATERIALS AND METHODS Following the approval from the institutional review board, a prospectively maintained trauma database was reviewed for renal trauma patient demographics, management, and mechanisms of injury. Data were reviewed first for the entire cohort and then incrementally to identify mechanisms of injury associated with increasing frequency or grade of injury. RESULTS A total of 228 graded renal injuries were identified from 1993 to 2013. The majority of renal injuries occurred in males (77.2%) >6 years of age (85.1%). Low grade (I-III) injuries were more common (70.6%). The most frequent mechanisms of injury identified were falls, recreational motor vehicle (RMV) accidents, bike accidents, motor vehicle collisions, and sports accidents, in descending order of frequency. RMV-related injuries have become frequent with time despite recommendations against use in the pediatric age population. Surgical intervention was rarely necessary. Over the 20 year study period, 5 nephrectomies (1.4%) were required, whereas 10 endoscopic interventions or percutaneous drainage procedures were needed (2.4%). CONCLUSION The majority of blunt pediatric renal injuries are low grade and can be managed nonoperatively. Nephrectomy is rarely required but is indicated for hemodynamic instability refractory to resuscitation. Pediatric blunt renal trauma secondary to RMV use is increasing despite recommendations against their use in the pediatric population.
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Affiliation(s)
- Pankaj P Dangle
- Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Thomas W Fuller
- Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Barbara Gaines
- Department of Pediatric Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Glenn M Cannon
- Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Francis X Schneck
- Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Heidi A Stephany
- Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michael C Ost
- Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Operative Interventionen urologischer Verletzungen beim schwerverletzten Patienten in der Akutphase. Urologe A 2016; 55:506-13. [DOI: 10.1007/s00120-015-0016-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lanchon C, Fiard G, Arnoux V, Descotes JL, Rambeaud JJ, Terrier N, Boillot B, Thuillier C, Poncet D, Long JA. High Grade Blunt Renal Trauma: Predictors of Surgery and Long-Term Outcomes of Conservative Management. A Prospective Single Center Study. J Urol 2016; 195:106-11. [DOI: 10.1016/j.juro.2015.07.100] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Cecilia Lanchon
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Gaëlle Fiard
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Valentin Arnoux
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | | | - Nicolas Terrier
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Bernard Boillot
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | | | - Delphine Poncet
- Department of Urology, Grenoble University Hospital, Grenoble, France
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Hoffner HE, Dagrosa LM, Raffin EP, Pais VM. Occult Congenital Ureteropelvic Junction Obstruction in Two Adults Presenting with Collecting System Rupture After Blunt Renal Trauma: A Case Report Series. J Endourol Case Rep 2015; 1:72-4. [PMID: 27579396 PMCID: PMC4996553 DOI: 10.1089/cren.2015.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report two adult cases of congenital ureteropelvic junction obstruction detected incidentally in the setting of blunt abdominal trauma. CT images are provided to describe the presentation, while review of the literature and management of renal trauma are discussed.
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Affiliation(s)
- Haley E. Hoffner
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Lawrence M. Dagrosa
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Eric P. Raffin
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Vernon M. Pais
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Zou Q, Fu Q. Diagnosis and treatment of acute urogenital and genitalia tract traumas: 10-year clinical experience. Pak J Med Sci 2015; 31:925-9. [PMID: 26430431 PMCID: PMC4590363 DOI: 10.12669/pjms.314.6116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To report our 10-year diagnosis and treatment experience of acute urogenital and genitalia tract traumas and outline the management of the traumatic injury. Methods: We reviewed the diagnoses and treatments of 208 cases of acute kidney, ureter, bladder, urethra, or male genitalia injuries in our department between March 2002 and March 2012. The patient data including general information, injury position and mechanism, diagnosis and treatment, the follow-up information was analyzed and summarized. Results: Of 62 patients with renal injury examined by ultrasound and computed tomography (CT) examination, 45 were treated conservatively, 9 with superselective arterial embolization, and 8 with nephrectomy. Intravenous pyelogram (IVP) was conducted in two patients with ureteral injury, one was treated with cystoscopic ureteral catheterization and the other with ureteric reimplantation. Bladder injury (6 patients) confirmed with a waterflood susceptibility test combined with CT scans underwent laparotomy and the bladder suturing was done. Of 92 patients with urethral injury, 6 were treated with a nonoperative approach (indwelling catheter), 18 with urethral realignment, 35 with cystoscopic urethral realignment, 29 with end-to-end anastomotic urethroplasty, and 4 with urethral repairmen. Of the 24 cases with penile injuries, 1 underwent conservative treatment, 8 were treated with debridement and suture ligation, and 15 were managed with suture repair of the penis white membrane. Of the 24 cases with penile injuries, 1 underwent conservative treatment, 8 were treated with debridement and suture ligation, and 15 were managed with suture repair of the penis white membrane. During the follow-up period, 62 patients with renal injury had normal renal function. Neither of the two patients with ureteral injury developed hydronephrosis. Twenty-nine patients with urethral injury suffered from urethral structure. All patients with vesical or genital injury recovered. Conclusions: Urethra and kidney injuries are the most common acute urogenital system traumas. Superselective arterial embolization can effectively cease bleeding and maximally protect renal function and ureterorenoscopic realignment is an easily operative and minimally invasive technique in the treatment of urethral injuries. As diagnosis and treatment techniques continue to evolve, minimally invasive procedures should be widely used in acute urogenital trauma.
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Affiliation(s)
- Qingsong Zou
- Qingsong Zou, MD. Department of Urology, the Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai 200233, China
| | - Qiang Fu
- Qiang Fu, MD. Department of Urology, the Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai 200233, China
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Patel DP, Redshaw JD, Breyer BN, Smith TG, Erickson BA, Majercik SD, Gaither TW, Craig JR, Gardner S, Presson AP, Zhang C, Hotaling JM, Brant WO, Myers JB. High-grade renal injuries are often isolated in sports-related trauma. Injury 2015; 46:1245-9. [PMID: 25769197 PMCID: PMC4896140 DOI: 10.1016/j.injury.2015.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/02/2015] [Accepted: 02/08/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III-V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma. MATERIAL AND METHODS We identified patients with AAST grades III-V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into "Sport" or "Non-sport" related groups. Outcomes included rates of hypotension (systolic blood pressure <90mm Hg), tachycardia (>110bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury. RESULTS 320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p=0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p=0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, p<0.001). There was no difference in renal abbreviated injury scale scores. Sports related trauma was more likely to be isolated without other significant injury (69% vs. 39% (p<0.001)). Haemodynamic instability was present in 40% and 51% of sports and non-sports renal injuries (p=0.30). Sports injuries had lower transfusion (7% vs. 47%, p<0.001) and lower mortality rates (0% vs. 6%, p=0.004). There was no difference in renal-specific procedural interventions between the two groups (17% sports vs. 18% non-sports, p=0.95). CONCLUSIONS High-grade sports-related blunt renal trauma is more likely to occur in isolation without other abdominal or thoracic injuries and clinicians must have a high suspicion of renal injury with significant blows to the flank during sports activities.
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Affiliation(s)
- Darshan P. Patel
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States,Corresponding author at: The Center for Reconstructive Urology and Men’s Health, University of Utah Health Care, 30 N 1900 E, RM 3B208B, Salt Lake City, UT 84132, United States. Tel.: +1 801 587 1395; fax: +1 810 585 2891. (D.P. Patel)
| | - Jeffrey D. Redshaw
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States
| | - Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - Thomas G. Smith
- Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Bradley A. Erickson
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Sarah D. Majercik
- Division of Trauma and Surgical Critical Care, Department of Surgery, Intermountain Medical Center, Murray, UT, United States
| | - Thomas W. Gaither
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - James R. Craig
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States
| | - Scott Gardner
- Division of Trauma and Surgical Critical Care, Department of Surgery, Intermountain Medical Center, Murray, UT, United States
| | - Angela P. Presson
- Division of Epidemiology, University of Utah, Salt Lake City, UT, United States
| | - Chong Zhang
- Division of Epidemiology, University of Utah, Salt Lake City, UT, United States
| | - James M. Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States
| | - William O. Brant
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States
| | - Jeremy B. Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States
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Monroe EJ, Kogut MJ, Ingraham CR. Traumatic renal vein pseudoaneurysm. J Vasc Surg Cases 2015; 1:157-160. [PMID: 31724584 PMCID: PMC6849883 DOI: 10.1016/j.jvsc.2015.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022] Open
Abstract
Traumatic renal injury is infrequent, occurring in ∼1% to 3% of trauma cases, with major renal vein injury an even more rare traumatic entity. Conservative, operative, and endovascular management strategies have been infrequently reported in the literature. We report a patient with traumatic renal vein injury with pseudoaneurysm formation that was successfully treated with endovascular stenting.
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Affiliation(s)
- Eric J Monroe
- Department of Interventional Radiology, University of Washington, Seattle, Wash
| | - Matthew J Kogut
- Department of Interventional Radiology, University of Washington, Seattle, Wash
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Maarouf A, Ahmed AF, Shalaby E, Badran Y, Salem E, Zaiton F. Factors predicting the outcome of non-operative management of high-grade blunt renal trauma. AFRICAN JOURNAL OF UROLOGY 2015. [DOI: 10.1016/j.afju.2014.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel. Eur Urol 2015; 67:930-6. [PMID: 25578621 DOI: 10.1016/j.eururo.2014.12.034] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/18/2014] [Indexed: 11/22/2022]
Abstract
CONTEXT The most recent European Association of Urology (EAU) guidelines on urological trauma were published in 2014. OBJECTIVE To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment. EVIDENCE ACQUISITION The EAU trauma guidelines panel reviewed literature by a Medline search on upper urinary tract injuries; publication dates up to December 2013 were accepted. The focus was on newer publications and reviews, although older key references could be included. EVIDENCE SYNTHESIS A full version of the guidelines is available in print and online. Blunt trauma is the main cause of renal injuries. The preferred diagnostic modality of renal trauma is computed tomography (CT) scan. Conservative management is the best approach in stable patients. Angiography and selective embolisation are the first-line treatments. Surgical exploration is primarily for the control of haemorrhage (which may necessitate nephrectomy) and renal salvage. Urinary extravasation is managed with endourologic or percutaneous techniques. Complications may require additional imaging or interventions. Follow-up is focused on renal function and blood pressure. Penetrating trauma is the main cause of noniatrogenic ureteral injuries. The diagnosis is often made by CT scanning or at laparotomy, and the mainstay of treatment is open repair. The type of repair depends upon the severity and location of the injury. CONCLUSIONS Renal injuries are best managed conservatively or with minimally invasive techniques. Preservation of renal units is feasible in most cases. This review, performed by the EAU trauma guidelines panel, summarises the current management of upper urinary tract injuries. PATIENT SUMMARY Patients with trauma benefit from being accurately diagnosed and treated appropriately, according to the nature and severity of their injury.
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McCombie SP, Thyer I, Corcoran NM, Rowling C, Dyer J, Le Roux A, Kuan M, Wallace DMA, Hayne D. The conservative management of renal trauma: a literature review and practical clinical guideline from Australia and New Zealand. BJU Int 2014; 114 Suppl 1:13-21. [DOI: 10.1111/bju.12902] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Steve P. McCombie
- School of Surgery; University of Western Australia; Crawley WA Australia
- Department of Urology; Fremantle Hospital; Fremantle WA Australia
| | - Isaac Thyer
- Department of Urology; Fremantle Hospital; Fremantle WA Australia
| | - Niall M. Corcoran
- Departments of Urology and Surgery; Royal Melbourne Hospital and University of Melbourne; Parkville VIC Australia
| | | | - John Dyer
- Department of Infectious Diseases; Fremantle Hospital; Fremantle WA Australia
| | - Anton Le Roux
- Department of Radiology; Fremantle Hospital; Fremantle WA Australia
| | - Melvyn Kuan
- Department of Urology; Fremantle Hospital; Fremantle WA Australia
| | | | - Dickon Hayne
- School of Surgery; University of Western Australia; Crawley WA Australia
- Department of Urology; Fremantle Hospital; Fremantle WA Australia
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Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, Erickson BA, Holzbeierlein J, Hudak SJ, Pruitt JH, Reston JT, Santucci RA, Smith TG, Wessells H. Urotrauma: AUA guideline. J Urol 2014; 192:327-35. [PMID: 24857651 DOI: 10.1016/j.juro.2014.05.004] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE The authors of this guideline reviewed the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. MATERIALS AND METHODS A systematic review of the literature using the MEDLINE® and EMBASE databases (search dates 1/1/90-9/19/12) was conducted to identify peer-reviewed publications relevant to urotrauma. The review yielded an evidence base of 372 studies after application of inclusion/exclusion criteria. These publications were used to inform the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS Guideline statements were created to inform clinicians on the initial observation, evaluation and subsequent management of renal, ureteral, bladder, urethral and genital traumatic injuries. CONCLUSIONS Genitourinary organ salvage has become increasingly possible as a result of advances in imaging, minimally invasive techniques, and reconstructive surgery. As the field of genitourinary reconstruction continues to evolve, clinicians must strive to approach clinical problems in a creative, multidisciplinary, evidence-based manner to ensure optimal outcomes.
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Affiliation(s)
- Allen F Morey
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Steve Brandes
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Daniel David Dugi
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - John H Armstrong
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Benjamin N Breyer
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Joshua A Broghammer
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Bradley A Erickson
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Jeff Holzbeierlein
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Steven J Hudak
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Jeffrey H Pruitt
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - James T Reston
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Richard A Santucci
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Thomas G Smith
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Hunter Wessells
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
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Shoobridge JJ, Bultitude MF, Koukounaras J, Royce PL, Corcoran NM. Predicting surgical exploration in renal trauma. J Trauma Acute Care Surg 2013; 75:819-23. [DOI: 10.1097/ta.0b013e3182a8fff5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Complex genitourinary injuries--associated with lower-extremity amputation as well as pelvic and abdominal wounding--have emerged as common occurrences in current military combat operations. The nature of combat injuries of the genitourinary tract is varied, as are the strategies used in their management. For example, 5% of all combat injuries include wounds of the urinary system or genitalia. For injuries that are predominantly penetrating in nature, immediate care requires the judicious preservation of viable tissue. Once the patient is stable, urethral, corporal and testicular lacerations are closed primarily, whereas soft tissue injuries are re-approximated in a delayed fashion. Negative-pressure dressings have been a useful aid in wound management; wound coverage is most commonly completed with split-thickness skin grafts and local flaps. Complex penile and urethral reconstructions are often delayed so orthopaedic injuries can heal and the patient can manage activities of daily living. Final reconstruction requires a urologist with a full understanding of reconstructive techniques.
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50
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Shoobridge JJ, Bultitude MF, Koukounaras J, Martin KE, Royce PL, Corcoran NM. A 9-year experience of renal injury at an Australian level 1 trauma centre. BJU Int 2013; 112 Suppl 2:53-60. [DOI: 10.1111/bju.12003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Matthew F. Bultitude
- Urology Centre, Guy's and St. Thomas' Hospital NHS, Foundation Trust; Guy's Hospital; London UK
| | - Jim Koukounaras
- Department of Radiology; Alfred Hospital; Melbourne Vic. Australia
| | | | - Peter L. Royce
- Department of Urology; Alfred Hospital; Melbourne Vic. Australia
| | - Niall M. Corcoran
- Department of Surgery; Royal Melbourne Hospital; University of Melbourne; Parkville Vic. Australia
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