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51 Renal trauma. Analysis in our series of conservative versus surgical treatment: Management and complications
51
Renal trauma. Analysis in our series of conservative versus surgical treatment: Management and complications Eur Urol Suppl 2016;15(3);e51
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Blanco Chamorro C.1 , Garcia Ruiz R.2 , Tejero Sanchez A. 2 , Suarez Broto M.A.2 , Serrano Frago P. 2 , Fantova Alonso A. 2 , Cabañuz Plo T.2 , Muñoz Rivero M. 2 , Gil Sanz M.J.2 1 Hospital
Universitario Miguel Servet, Zaragoza, Spain, 2 Hospital Universitario Miguel Servet, Dept. of Urology, Zaragoza, Spain
INTRODUCTION & OBJECTIVES: Kidney injuries account for 10% of abdominal trauma. Proper management of high grade is still controversial. The attitude renal trauma has undergone significant change in recent years, now being more conservative than in the past. This has happened thanks to the improvement in diagnostic imaging, management of critically ill patients and the development and implementation of a subspecialty such as interventional radiology methods. Also, the incidence of renal abnormalities in patients with renal trauma is of 4.4 to 19%. Serious injuries often have minor trauma and less intra-abdominal injuries. The main anomalies described are: hydronephrosis, cysts, tumors and malpositions. Sometimes, surgery is indicated by the underlying disease and not the severity of injury. Our goal is to compare the results and complications as conservative or surgical treatment in our series. MATERIAL & METHODS: From January 2000 to May 2015 they were recorded in our hospital 152 renal trauma. Retrospective study of 122 cases is performed by analyzing their causes, extent, clinical and therapeutic complications according to the attitude adopted. RESULTS:
N Type of Trauma Closed 120 Opened 2 Sex 96 Man 26 Woman Kidney affected Left 72 Right 48 Bilateral 2 Due to trauma Weapons 2 Bull Horn 1 Precipitation 32 Traffic Accident 56 Others 31
% 97,7 2,2 76,6 23,3 62,2 36,6 1,1 2,2 1,1 21,1 48,8 26,6
Prior kidney disease Hidronefrosis Tumor Polycystic
N 4 3 6
% 12,2 1,1 2,2 5,5
Simple Cystic Kydney trasplant Clinical diagnosis Hematuria Pain Incidental Hemodinamic inestability Associated injuries Politraumatism Bones injuries Visceral injuries
2 1 50 31 34 6 37 17 17
2,2 1,1 44,4 26,6 24,4 6,6 26,6 17,7 13,3
Median age: 25 years (3-83). 34% were under 15 years. Revenue in Urology: 41 cases [average stay of 11.66 days (2-51)]
Gº AAST N % Treatment I 67 62,2 Conservative II 26 12,2 Conservative Conservative III 17 15,5 1 Surgical repair 4 Conservative IV 6 5,5 2 surgical repair 4 Nefrectomy V 6 4,4 1 surgical repair 1 Conservative
Complications Ø Ø 1 embolization for bleeding 1 surgery + repair 1 Urinary leakage→ Nefrostomy and catheterization Ø Ø
In cases of conservative treatment, renal preservation was achieved in all patients. The resulting complications can be treated with less aggressive techniques with good results. CONCLUSIONS: 1. In general, renal trauma are caused by multiple injuries and only enter 34% in the urology department. 2. Our series presents a similar incidence of renal anomalies described in the literature. We believe that conservative management may be performed despite the existence of renal anomalies and plan if necessary, without observing an increase in the number of complications deferred surgery. 3. We consider the conservative approach adequate for major renal trauma even in high-grade, provided there is hemodynamic stability. generally it is more aggressive in the treatment of patients with multiple trauma than in patients with only renal injury. 4. Embolization is a procedure boom that offers very good results without resorting to radical surgery. 5. In subsequent tests (ultrasound), it is not objective in the majority of cases, no functional alteracional in the kidney affection, even in grade IV-V injuries.
Renal trauma. Analysis in our series of conservative versus surgical treatment: Management and complications Eur Urol Suppl 2016;15(3);e51
Print! Print!
Blanco Chamorro C.1 , Garcia Ruiz R.2 , Tejero Sanchez A. 2 , Suarez Broto M.A.2 , Serrano Frago P. 2 , Fantova Alonso A. 2 , Cabañuz Plo T.2 , Muñoz Rivero M. 2 , Gil Sanz M.J.2 1 Hospital
Universitario Miguel Servet, Zaragoza, Spain, 2 Hospital Universitario Miguel Servet, Dept. of Urology, Zaragoza, Spain
INTRODUCTION & OBJECTIVES: Kidney injuries account for 10% of abdominal trauma. Proper management of high grade is still controversial. The attitude renal trauma has undergone significant change in recent years, now being more conservative than in the past. This has happened thanks to the improvement in diagnostic imaging, management of critically ill patients and the development and implementation of a subspecialty such as interventional radiology methods. Also, the incidence of renal abnormalities in patients with renal trauma is of 4.4 to 19%. Serious injuries often have minor trauma and less intra-abdominal injuries. The main anomalies described are: hydronephrosis, cysts, tumors and malpositions. Sometimes, surgery is indicated by the underlying disease and not the severity of injury. Our goal is to compare the results and complications as conservative or surgical treatment in our series. MATERIAL & METHODS: From January 2000 to May 2015 they were recorded in our hospital 152 renal trauma. Retrospective study of 122 cases is performed by analyzing their causes, extent, clinical and therapeutic complications according to the attitude adopted. RESULTS:
N Type of Trauma Closed 120 Opened 2 Sex 96 Man 26 Woman Kidney affected Left 72 Right 48 Bilateral 2 Due to trauma Weapons 2 Bull Horn 1 Precipitation 32 Traffic Accident 56 Others 31
% 97,7 2,2 76,6 23,3 62,2 36,6 1,1 2,2 1,1 21,1 48,8 26,6
Prior kidney disease Hidronefrosis Tumor Polycystic
N 4 3 6
% 12,2 1,1 2,2 5,5
Simple Cystic Kydney trasplant Clinical diagnosis Hematuria Pain Incidental Hemodinamic inestability Associated injuries Politraumatism Bones injuries Visceral injuries
2 1 50 31 34 6 37 17 17
2,2 1,1 44,4 26,6 24,4 6,6 26,6 17,7 13,3
Median age: 25 years (3-83). 34% were under 15 years. Revenue in Urology: 41 cases [average stay of 11.66 days (2-51)]
Gº AAST N % Treatment I 67 62,2 Conservative II 26 12,2 Conservative Conservative III 17 15,5 1 Surgical repair 4 Conservative IV 6 5,5 2 surgical repair 4 Nefrectomy V 6 4,4 1 surgical repair 1 Conservative
Complications Ø Ø 1 embolization for bleeding 1 surgery + repair 1 Urinary leakage→ Nefrostomy and catheterization Ø Ø
In cases of conservative treatment, renal preservation was achieved in all patients. The resulting complications can be treated with less aggressive techniques with good results. CONCLUSIONS: 1. In general, renal trauma are caused by multiple injuries and only enter 34% in the urology department. 2. Our series presents a similar incidence of renal anomalies described in the literature. We believe that conservative management may be performed despite the existence of renal anomalies and plan if necessary, without observing an increase in the number of complications deferred surgery. 3. We consider the conservative approach adequate for major renal trauma even in high-grade, provided there is hemodynamic stability. generally it is more aggressive in the treatment of patients with multiple trauma than in patients with only renal injury. 4. Embolization is a procedure boom that offers very good results without resorting to radical surgery. 5. In subsequent tests (ultrasound), it is not objective in the majority of cases, no functional alteracional in the kidney affection, even in grade IV-V injuries.