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Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, Matsumura Y, Kim F, Peitzman AB, Fraga GP, Sartelli M, Ansaloni L, Augustin G, Kirkpatrick A, Abu-Zidan F, Wani I, Weber D, Pikoulis E, Larrea M, Arvieux C, Manchev V, Reva V, Coimbra R, Khokha V, Mefire AC, Ordonez C, Chiarugi M, Machado F, Sakakushev B, Matsumoto J, Maier R, di Carlo I, Catena F. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14:54. [PMID: 31827593 PMCID: PMC6886230 DOI: 10.1186/s13017-019-0274-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy
| | | | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus, Haifa, Israel
| | - Walter Biffl
- Trauma Surgery Dept., Scripps Memorial Hospital, La Jolla, California USA
| | - Ari Leppaniemi
- General Surgery Dept., Mehilati Hospital, Helsinki, Finland
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan
| | - Fernando Kim
- Urology Department, University of Colorado, Denver, USA
| | | | - Gustavo P. Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Imitiaz Wani
- Department of Surgery, DHS Hospitals, Srinagar, Kashmir India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Martha Larrea
- General Surgery, “General Calixto García”, Habana Medicine University, Havana, Cuba
| | - Catherine Arvieux
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Raul Coimbra
- Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mozir, Belarus
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics and Gynecology, University of Buea, Buea, Cameroon
| | - Carlos Ordonez
- Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy
| | - Fernando Machado
- General and Emergency Surgery Department, Montevideo Hospital, Montevideo, Paraguay
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Isidoro di Carlo
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
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Ethylene Vinyl Alcohol Copolymer Embolization for Acute Renal Hemorrhage: Initial Experience in 24 Cases. AJR Am J Roentgenol 2019; 214:465-471. [PMID: 31714850 DOI: 10.2214/ajr.19.21508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the efficacy and safety of ethylene vinyl alcohol (EVOH) copolymer (Onyx, Medtronic) for embolization for acute renal hemorrhage. MATERIALS AND METHODS. Between October 2006 and June 2018, 24 consecutive patients were treated by embolization with EVOH copolymer for acute renal hemorrhage at Hôpital Bichat-Claude-Bernard. CT angiography was performed in all patients before treatment. Technical success was defined as the complete occlusion of the bleeding artery on final renal angiogram. Clinical success was defined as the absence of rebleeding after embolization. Complications mid procedure, infarcted renal area on final angiogram, and renal function 1 week after embolization were retrospectively analyzed. RESULTS. Active bleeding was observed in all cases. The causes of acute renal hemorrhage were iatrogenic in 12 patients, vascular malformation in four patients, renal tumor in four patients, and unknown in four patients. EVOH copolymer was the sole embolic agent used in 16 patients. In eight patients, EVOH copolymer was used after persistent bleeding after embolization with coils. Technical and clinical success rates were 100%. No patient required surgery or new embolization during a mean follow-up period of 35 months (range, 6-86 months). No serious complications were attributable to EVOH copolymer. The mean infarcted renal area was 10% (range, 5-30%). Renal function, available for 16 (67%) patients, was not altered 1 week after embolization. CONCLUSION. EVOH copolymer is safe and effective for embolization of acute renal hemorrhage, either as a first-line embolic agent or after failure of coil embolization.
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Pediatric blunt renal trauma practice management guidelines: Collaboration between the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society. J Trauma Acute Care Surg 2019; 86:916-925. [DOI: 10.1097/ta.0000000000002209] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Mao Q, Zhong B, Lin Y, Wang C, Liang W, Tan F, Shen B, Xie L. Clinical application of computed tomographic angiography in patients with renal arterial hemorrhage: Diagnostic accuracy and subsequent therapeutic outcome. Exp Ther Med 2015; 10:508-512. [PMID: 26622345 DOI: 10.3892/etm.2015.2535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 05/15/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to determine the accuracy of multi-section computed tomographic angiography (CTA) for the diagnosis of renal arterial h=emorrhage in comparison with digital subtraction angiography (DSA) and the effect of diagnostic outcome on therapeutic patient management. A retrospective analysis was conducted of the records of all patients undergoing DSA for acute renal hemorrhage between August 2005 and June 2014. A total of 74 patients were identified in whom CTA was performed prior to the DSA. DSA detected a renal arterial lesion in 68 cases and no bleeding was demonstrated in 6 cases. CTA correctly identified the bleeding site in 59 of the 68 DSA-positive cases. There were 14 patients with negative CTA results that underwent DSA after 2-10 days because of persistent hematuria, and 9 of them were found to have positive DSA results. The sensitivity, specificity, positive predictive value and negative predictive value of CTA for the detection of arterial lesions in the context of acute renal hemorrhage were 0.868, 0.833, 0.983 and 0.357, respectively. All patients with bleeding sites identified by DSA underwent superselective embolization in a single session. Five patients underwent a secondly embolization for recurrent hemorrhage. These results indicate that CTA is an accurate technique for the detection of major arterial hemorrhage and supports its use in the initial examination of these patients.
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Affiliation(s)
- Qiqi Mao
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Baishu Zhong
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yiwei Lin
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Chaojun Wang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Wenjie Liang
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Fuqing Tan
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Bohua Shen
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Liping Xie
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Sawant A, Kumar V, Bhalerao S, Badne A. Successful revascularisation following delayed presentation of bilateral renal artery thrombosis after blunt abdominal trauma. TRAUMA-ENGLAND 2014. [DOI: 10.1177/1460408614525733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic blunt abdominal bilateral renal artery thrombosis is a rare entity leading to end stage renal disease and has significant morbidity due to renal replacement therapy. Previously many attempts of revascularisation beyond 24 h have led to failure. We report a case of delayed presentation of bilateral renal artery thrombosis in which revascularisation was attempted beyond 24 h and was successful in terms of patient becoming dialysis-free.
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Affiliation(s)
- Ajit Sawant
- Department of Urology, LTMMC and LTMGH, Sion, Mumbai; affiliated to Maharashtra University of Health Sciences, Nashik, India
| | - Vikash Kumar
- Department of Urology, LTMMC and LTMGH, Sion, Mumbai; affiliated to Maharashtra University of Health Sciences, Nashik, India
| | - Sagar Bhalerao
- Department of Urology, LTMMC and LTMGH, Sion, Mumbai; affiliated to Maharashtra University of Health Sciences, Nashik, India
| | - Avinash Badne
- Department of Urology, LTMMC and LTMGH, Sion, Mumbai; affiliated to Maharashtra University of Health Sciences, Nashik, India
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Xu RX, Li YK, Li T, Wang SS, Yuan GZ, Zhou QF, Zheng HR, Yan F. Real-time 3-dimensional contrast-enhanced ultrasound in detecting hemorrhage of blunt renal trauma. Am J Emerg Med 2013; 31:1427-31. [PMID: 23969280 DOI: 10.1016/j.ajem.2013.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The objective of this study is to evaluate the diagnostic value of real-time 3-dimensional contrast-enhanced ultrasound in the hemorrhage of blunt renal trauma. METHODS Eighteen healthy New Zealand white rabbits were randomly divided into 3 groups. Blunt renal trauma was performed on each group by using minitype striker. Ultrasonography, color Doppler flow imaging, and contrast-enhanced 2-dimensional and real-time 3-dimensional ultrasound were applied before and after the strike. The time to shock and blood pressure were subjected to statistical analysis. Then, a comparative study of ultrasound and pathology was carried out. RESULTS All the struck kidneys were traumatic. In the ultrasonography, free fluid was found under the renal capsule. In the color Doppler flow imaging, active hemorrhage was not identified. In 2-dimensional contrast-enhanced ultrasound, active hemorrhage of the damaged kidney was characterized. Real-time 3-dimensional contrast-enhanced ultrasound showed a real-time and stereoscopic ongoing bleeding of the injured kidney. The wider the hemorrhage area in 4-dimensional contrast-enhanced ultrasound was, the faster the blood pressure decreased. CONCLUSIONS Real-time 3-dimensional contrast-enhanced ultrasound is a promising noninvasive tool for stereoscopically and vividly detecting ongoing hemorrhage of blunt renal trauma in real time.
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Affiliation(s)
- Rui-Xue Xu
- Department of Ultrasound, Liuhuaqiao Hospital, Guangzhou 510010, China
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Computed tomographic imaging in determining the need of embolization for high-grade blunt renal injury. J Trauma Acute Care Surg 2013; 74:230-5. [DOI: 10.1097/ta.0b013e318270e156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huber J, Pahernik S, Hallscheidt P, Sommer CM, Wagener N, Hatiboglu G, Haferkamp A, Hohenfellner M. Selective Transarterial Embolization for Posttraumatic Renal Hemorrhage: A Second Try is Worthwhile. J Urol 2011; 185:1751-5. [DOI: 10.1016/j.juro.2010.12.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Indexed: 11/15/2022]
Affiliation(s)
- Johannes Huber
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Sascha Pahernik
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Peter Hallscheidt
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Christof M. Sommer
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Nina Wagener
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Gencay Hatiboglu
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Axel Haferkamp
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Markus Hohenfellner
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
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Management of blunt renal trauma: an experience in 84 children. Int Urol Nephrol 2011; 43:937-42. [DOI: 10.1007/s11255-011-9965-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 04/05/2011] [Indexed: 10/18/2022]
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Lv F, Tang J, Luo Y, Li Z, Meng X, Zhu Z, Li T. Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma. Radiol Med 2011; 116:1076-82. [PMID: 21509551 DOI: 10.1007/s11547-011-0680-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Accepted: 08/30/2010] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate contrast-enhanced ultrasound (CEUS) imaging of active bleeding from hepatic and splenic trauma. MATERIALS AND METHODS Three hundred and ninety-two patients with liver or/and spleen trauma (179 liver and 217 spleen injuries), who underwent CEUS examinations following contrast-enhanced computed tomography (CT), were enrolled in this retrospective study over a period of >4 years. CEUS detected contrast medium extravasation or pooling in 16% (63/396) of liver or spleen lesions in 61 patients, which was confirmed by contrast-enhanced CT. Special attention was paid to observing the presence, location, and characteristics of the extravasated or pooled contrast medium. RESULTS The CEUS detection rate for active bleeding was not different from that of contrast-enhanced CT (p=0.333). Information from surgery, minimally invasive treatment and conservative treatment was used as reference standard, and the sensitivities of the two techniques were not different (p=0.122). Of 63 lesions in 61 patients, CEUS showed that 74.6% (47/63) (21 liver lesions and 26 spleen lesions) presented contrast medium extravasation or pooling, both in the organ and out the capsule, in 14.3% (9/63) and only outside the capsule in 11.1% (7/63). CEUS imaging of active bleeding from hepatic and splenic trauma presented various characteristics, and the sizes and shapes of the active bleeding due to contrast medium extravasation or pooling were variable. CONCLUSIONS CEUS can show the active bleeding associated with hepatic and splenic trauma with various imaging characteristics, thus making it possible to diagnose active bleeding using CEUS.
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Affiliation(s)
- F Lv
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China
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Sommer CM, Stampfl U, Bellemann N, Ramsauer S, Loenard BM, Haferkamp A, Hallscheidt P, Richter GM, Kauczor HU, Radeleff BA. Patients with Life-Threatening Arterial Renal Hemorrhage: CT Angiography and Catheter Angiography with Subsequent Superselective Embolization. Cardiovasc Intervent Radiol 2010; 33:498-508. [DOI: 10.1007/s00270-009-9787-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
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Alonso RC, Nacenta SB, Martinez PD, Guerrero AS, Fuentes CG. Kidney in Danger: CT Findings of Blunt and Penetrating Renal Trauma. Radiographics 2009; 29:2033-53. [DOI: 10.1148/rg.297095071] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Affiliation(s)
- Andrew Holden
- Interventional Radiology Services, Auckland City Hospital, New Zealand.
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