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925Setting up of a kidney trauma network in the ALPS
925 SETTING UP OF A KIDNEY TRAUMA N E T W O R K IN THE ALPS
926 TERROR-RELATED UROLOGICAL INJURIES IN ISRAEL BETWEEN 1997-2003
Rambeaud J.J?, Skowron 0 . 2 , Combe M . 3 , Bondil E 4, Francois 0. 5, Hamiche A 6, Lelore j.7 Boillot B.a, Terrier N.a, Descotes J.a ~CHU Grenoble, Urology, Grenoble, France, 2Ctt Annecy, Urology, Armecy, France, 3CH Gap, Urology, Gap, France, 4CH Chambery, Urology, Chambery, France, sCH Sallanches, Urology, Sallanches, France, 6CH Bourg St Manrice, Urology, Bourg St Maurice, France, 7CH Moutiers, Urology, Moutiers, France INTRODUCTION & OBJECTIVES: Our department is located in the central part of French Alps, therefore the trauma centre is active and has a specific expertise in blunt renal trauma. We associated 7 hospitals working in a same large area to evaluate the outcome and long follow up of blunt renal trauma managed with same guidelines. We present the results of a 9 month activity of the French observatory of renal trauma in Alps. MATERIAL & METHODS: Guidelines were edited to handle renal injuries in the 8 different trauma centres, according to work up, conservative or surgical management and follow up. An Urological surgeon his the data manager in each centre. Renal injuries are classified according to the American classification. Data are collected one line in the central trauma centre of Grenoble. RESULTS: From January to October 2004, 45 patients enter this prospective study. 83% of the patients were male. Winter ski injuries represent 78% of our cases, 41% for surf accidents. According to the American grading: 23% grade I, 20% grade II, 23% grade III, 28% grade IV and 6% for grade V. Surgery was needed in 6 cases, ureteral stent in3, evacuation of urohematoma for 1, pedicular surgey in 1 and 1 nephrectomy for grade V. CONCLUSIONS: Furthers studies are needed to increase the number of patients and to offer results according to conservative treatment and long term follow up. This presentation show the feasibility of a trauma network based on 8 different hospitals. The next results could be of interest on epidemiologic area, evaluation of management and long term results.
Kitrey N.~, Peleg K.2, Given A.2, Ramon J. 1, Mor Y? ~Chaim Sheba Medical Centre, Urology, Ramat Gan, Israel, 2Gertner Institute, lsrael National Centre for Trauma, Ramat Gan, Israel INTRODUCTION & OBJECTIVES: With the increase of terror activities over the past few years, there is an emerging need to study the characteristics of terror-related trauma to the urogenital system. The paucity of data is evident mainly about blast or explosion urologicaI injuries. We aimed to describe the features of injuries of the urogenital system among patients who were wounded in terror activities, and compare between gunshot (GSW) and explosion injuries in this group. MATERIAL & METHODS: We conducted a retrospective cohort study concerning terror-related trauma patients with urological injuries, treated in Israel between 19972003. Data was obtained from the Israel Trauma Registry (ITR) that records all hospitalizations for physical trauma in most of the Israeli trauma centers, which treat the majority of trauma cases and almost all the severe and the most complicated cases. The factors that were collected included: demographic features, mechanism of injury (GSW vs. explosion), severity of injury (ICU, duration of inpatient stay), clinical diagnosis and injured organs, operative procedures, and survival. RESULTS: 68 out of 2432 patients recorded in the ITR (2%) had urological injuries. In all patients the urological injury was part of a combined or multi-tranma injury. 23 patients (34%) were injured from explosions, while 40 patients (59%) had GSW's. The majority of patients were males (60, 88%) and young (ages 15-29: 42, 62%). About half the patients were treated in intensive care units (36, 53%) or hospitalized for more than two weeks (31, 46%) and 13 patients (19%) died during the hospitalization period. About a third of the patients (26, 38%) underwent immediate urological operations close to their admission to the hospital, usually by a multi-disciplinary team, while only 4 (6%) were operated at later stages. Comparing explosion and GSW injuries reveals that the incidence of renal trauma was similar (65% vs. 63%, respectively), bladder trauma was more common in GSW injuries (17% vs. 9%), and trauma to the external genitalia was more common among explosion victims (26% vs. 14%). Five patients have lost kidneys (all injured from GSW's), while 2 patients have lost testicles (1 from each group). CONCLUSIONS: Terror-related trauma injuries to the urogenital system are relatively rare and almost always part of a multi-trauma injury. Therefore, preparedness of the medical teams to terror-related urological injuries requires improved cooperation with the general surgery departments, and adaptation of damage control principles in urology.
927
928
CHANGES OF KIDNEY INJURY PATIENT MANAGEMENT IN POLAND IN THE YEARS 1995-1999 AND 2000-2001
M I N I M A L L Y INVASIVE TREATMENT OF U R E T E R I C I N J U R I E S AFTER NON-UROLOGY ASSOCIATED SURGERY
Hahrat W. LipczyflskiW., DobrowolskaB., Michalski L., DobrowolskiZ. Collegium Medicum Jagiellunian University, Clicnic and Department of Urology, Cracow, Poland INTRODUCTION & OBJECTIVES: The number of multi-organinjuries including kidney tranma has increased in the last years. In year 2000, 57,331 traffic accidents were recorded in Poland, in which 7,163 people were injured. In comparison with data from 1999 there was 4% increase in the number of traffic accidents and 4.6% increase in the number of injured people (Police data). MATERIAL & METHODS: There were analyzed 887 kidney injuries from 61 urological departments in the years 1995-99 and 324 kidney injuries from 39 urological departments in the years 2000-01. RESULTS: In years 1995-1999, 97% of injuries were caused by blunt renal trauma. Urography was performed in 80% of cases and Computed Tomographyin 20% of cases. Most of the blunt injuries were classified as renal contusionor renal rupturewith a subcapsular haematoma damage in 687 cases (I or II in Dobrowolskiscale). Surgerytreatment was carried out in 234 patients (26%). Nephrectomywas perfomaed in 170 cases, which means 73% of operated patients, in the years 2000 - 2001, 324 kidney injuries were treated in 39 of Polish urological departments. 9 open injuries (3% of all kidney traumas) and 315 blunt kidney injuries (97% of all kidney traumas) were confirmed. Severe renal injury like renal pelvis damage, ureter tear-off, damage of main renal artery or vein and multiple lacerations were confirmed in 21 cases. 77 (24%) kidney injuries accompanied multi-organ trartma. The most frequent injured organ appeared to be the spleen (29 cases it means 39% of multi-organ injuries) and liver (14 cases - 18%). The diagnostic methods were as follows: Computed Tomography with contrast infusion (126 cases); Intravenous Urography (259 cases) and Ultrasonography in all cases. Conservative treatment was applied in 214 cases (64%) and surgical one in 110 cases (34%). Surgical treatment in urgent manner was preformed in 82 cases (75% of operated patients) and in delayed manner in I2 cases. Minimal invasive surgery was performed in urgent mode in 21 cases and delayed in 8 cases. CONCLUSIONS: There was the same rate of blunt trauma (97%) and open injuries (3%) in both periods. The rate of renal damage from I to V in Dobrowolskiscale was higher in years 1995 - 99: 77% vs. 66%. The rate of concomitant multi-organ trauma was 27% vs. 24%. In both periods the spleen (29% and 39%) and liver ( 19% and 18%) were damaged most often. Computed Tomog-raphywas used twice as often in period of 2000-01: 39% of eases. It was used only in 20% of cases in 1995-99. Ultrasonographywas commonlyused in both periods to monitor the conservative treatment. The rate of conservative treatment was higher in the former period (74% vs. 66%). It means that surgical treatment was more frequent in the years 2000 - 2001 (34% vs. 26%). However,the rate ofnephrectomy was significantly lower in the latter period: 73% vs. 42%. The time from injury to establishing diagnosis was shorter in the years 2000 -2001:222 rain vs.104 rain.
European Urology Supplements 4 (2005) No. 3, pp. 234
Liatsikos E. a, Kraniotis p.2, Siablis D. 1, Kagadis G. 3, Voudoukis T.4, Karnabatidis D. 2, Papathanasiou Z. 2, Barbalias G. a ~University Hospital of Patras, School of Medicine, Patras, Greece, 2University Hospital of Patras, Radiology, Patras, Greece, 3University of Patras, Medical Physics, Patras, Greece, 4University Hospital of Patras, Urology, Patras, Greece INTRODUCTION & OBJECTIVES: To evaluate the efficacy and safety of percutaneous nephrostomy and primary antegrade management for treating inadvertent iatrogenic ureteric injuries. MATERIAL & METHODS: We evaluated 10 patents who were referred for ureteric trauma after gynecologic surgery. All patients developed symptoms suggestive of ureteral obstruction sometime dunng the postoperative period ranging between 5 days to 1 week after surgery. A standard percutaneous nephrostomy route was obtained. Using a long 7 Fr sheath, a hydrophilic. 0035 guide wire was negotiated through the ureteral stricture with the aid of a hydrophilic-angled 5 Fr catheter. The hydropbilic guide wire was then exchanged with an Amplatz superstiff .0035 guide wire. The strictures were then gradually dilated with the use of high-pressure (20 Atm) angioplasty balloon to a maximum of 7 mm in diameter. The mean stricture length was 1.4 cm (range 0.4- 1.9cm). An antegrade ureteral 8 Fr pig tail stent was then inserted though the stricture. RESULTS: The initial technical success was 100%. There were no major complications concerning either the nephrostomy access itself or the subsequent ureteral manipulations. The mean follow-up period was 1 year. In 6 patients (60%) a patent ureter was noted at t week and ureteral stunt was removed, while 4 patients required repeat dilation of the stricture and stent reimplantation. Ureteral stents were removed in all patients after a mean period of 4.8 weeks. CONCLUSIONS: Percutaneous nephrostomy and primary antegrade ureteral balloon dilation is safe and efficacious for treating ureteral injury after pelvic surgery and obviates the need for open surgical manipulations.
926 TERROR-RELATED UROLOGICAL INJURIES IN ISRAEL BETWEEN 1997-2003
Rambeaud J.J?, Skowron 0 . 2 , Combe M . 3 , Bondil E 4, Francois 0. 5, Hamiche A 6, Lelore j.7 Boillot B.a, Terrier N.a, Descotes J.a ~CHU Grenoble, Urology, Grenoble, France, 2Ctt Annecy, Urology, Armecy, France, 3CH Gap, Urology, Gap, France, 4CH Chambery, Urology, Chambery, France, sCH Sallanches, Urology, Sallanches, France, 6CH Bourg St Manrice, Urology, Bourg St Maurice, France, 7CH Moutiers, Urology, Moutiers, France INTRODUCTION & OBJECTIVES: Our department is located in the central part of French Alps, therefore the trauma centre is active and has a specific expertise in blunt renal trauma. We associated 7 hospitals working in a same large area to evaluate the outcome and long follow up of blunt renal trauma managed with same guidelines. We present the results of a 9 month activity of the French observatory of renal trauma in Alps. MATERIAL & METHODS: Guidelines were edited to handle renal injuries in the 8 different trauma centres, according to work up, conservative or surgical management and follow up. An Urological surgeon his the data manager in each centre. Renal injuries are classified according to the American classification. Data are collected one line in the central trauma centre of Grenoble. RESULTS: From January to October 2004, 45 patients enter this prospective study. 83% of the patients were male. Winter ski injuries represent 78% of our cases, 41% for surf accidents. According to the American grading: 23% grade I, 20% grade II, 23% grade III, 28% grade IV and 6% for grade V. Surgery was needed in 6 cases, ureteral stent in3, evacuation of urohematoma for 1, pedicular surgey in 1 and 1 nephrectomy for grade V. CONCLUSIONS: Furthers studies are needed to increase the number of patients and to offer results according to conservative treatment and long term follow up. This presentation show the feasibility of a trauma network based on 8 different hospitals. The next results could be of interest on epidemiologic area, evaluation of management and long term results.
Kitrey N.~, Peleg K.2, Given A.2, Ramon J. 1, Mor Y? ~Chaim Sheba Medical Centre, Urology, Ramat Gan, Israel, 2Gertner Institute, lsrael National Centre for Trauma, Ramat Gan, Israel INTRODUCTION & OBJECTIVES: With the increase of terror activities over the past few years, there is an emerging need to study the characteristics of terror-related trauma to the urogenital system. The paucity of data is evident mainly about blast or explosion urologicaI injuries. We aimed to describe the features of injuries of the urogenital system among patients who were wounded in terror activities, and compare between gunshot (GSW) and explosion injuries in this group. MATERIAL & METHODS: We conducted a retrospective cohort study concerning terror-related trauma patients with urological injuries, treated in Israel between 19972003. Data was obtained from the Israel Trauma Registry (ITR) that records all hospitalizations for physical trauma in most of the Israeli trauma centers, which treat the majority of trauma cases and almost all the severe and the most complicated cases. The factors that were collected included: demographic features, mechanism of injury (GSW vs. explosion), severity of injury (ICU, duration of inpatient stay), clinical diagnosis and injured organs, operative procedures, and survival. RESULTS: 68 out of 2432 patients recorded in the ITR (2%) had urological injuries. In all patients the urological injury was part of a combined or multi-tranma injury. 23 patients (34%) were injured from explosions, while 40 patients (59%) had GSW's. The majority of patients were males (60, 88%) and young (ages 15-29: 42, 62%). About half the patients were treated in intensive care units (36, 53%) or hospitalized for more than two weeks (31, 46%) and 13 patients (19%) died during the hospitalization period. About a third of the patients (26, 38%) underwent immediate urological operations close to their admission to the hospital, usually by a multi-disciplinary team, while only 4 (6%) were operated at later stages. Comparing explosion and GSW injuries reveals that the incidence of renal trauma was similar (65% vs. 63%, respectively), bladder trauma was more common in GSW injuries (17% vs. 9%), and trauma to the external genitalia was more common among explosion victims (26% vs. 14%). Five patients have lost kidneys (all injured from GSW's), while 2 patients have lost testicles (1 from each group). CONCLUSIONS: Terror-related trauma injuries to the urogenital system are relatively rare and almost always part of a multi-trauma injury. Therefore, preparedness of the medical teams to terror-related urological injuries requires improved cooperation with the general surgery departments, and adaptation of damage control principles in urology.
927
928
CHANGES OF KIDNEY INJURY PATIENT MANAGEMENT IN POLAND IN THE YEARS 1995-1999 AND 2000-2001
M I N I M A L L Y INVASIVE TREATMENT OF U R E T E R I C I N J U R I E S AFTER NON-UROLOGY ASSOCIATED SURGERY
Hahrat W. LipczyflskiW., DobrowolskaB., Michalski L., DobrowolskiZ. Collegium Medicum Jagiellunian University, Clicnic and Department of Urology, Cracow, Poland INTRODUCTION & OBJECTIVES: The number of multi-organinjuries including kidney tranma has increased in the last years. In year 2000, 57,331 traffic accidents were recorded in Poland, in which 7,163 people were injured. In comparison with data from 1999 there was 4% increase in the number of traffic accidents and 4.6% increase in the number of injured people (Police data). MATERIAL & METHODS: There were analyzed 887 kidney injuries from 61 urological departments in the years 1995-99 and 324 kidney injuries from 39 urological departments in the years 2000-01. RESULTS: In years 1995-1999, 97% of injuries were caused by blunt renal trauma. Urography was performed in 80% of cases and Computed Tomographyin 20% of cases. Most of the blunt injuries were classified as renal contusionor renal rupturewith a subcapsular haematoma damage in 687 cases (I or II in Dobrowolskiscale). Surgerytreatment was carried out in 234 patients (26%). Nephrectomywas perfomaed in 170 cases, which means 73% of operated patients, in the years 2000 - 2001, 324 kidney injuries were treated in 39 of Polish urological departments. 9 open injuries (3% of all kidney traumas) and 315 blunt kidney injuries (97% of all kidney traumas) were confirmed. Severe renal injury like renal pelvis damage, ureter tear-off, damage of main renal artery or vein and multiple lacerations were confirmed in 21 cases. 77 (24%) kidney injuries accompanied multi-organ trartma. The most frequent injured organ appeared to be the spleen (29 cases it means 39% of multi-organ injuries) and liver (14 cases - 18%). The diagnostic methods were as follows: Computed Tomography with contrast infusion (126 cases); Intravenous Urography (259 cases) and Ultrasonography in all cases. Conservative treatment was applied in 214 cases (64%) and surgical one in 110 cases (34%). Surgical treatment in urgent manner was preformed in 82 cases (75% of operated patients) and in delayed manner in I2 cases. Minimal invasive surgery was performed in urgent mode in 21 cases and delayed in 8 cases. CONCLUSIONS: There was the same rate of blunt trauma (97%) and open injuries (3%) in both periods. The rate of renal damage from I to V in Dobrowolskiscale was higher in years 1995 - 99: 77% vs. 66%. The rate of concomitant multi-organ trauma was 27% vs. 24%. In both periods the spleen (29% and 39%) and liver ( 19% and 18%) were damaged most often. Computed Tomog-raphywas used twice as often in period of 2000-01: 39% of eases. It was used only in 20% of cases in 1995-99. Ultrasonographywas commonlyused in both periods to monitor the conservative treatment. The rate of conservative treatment was higher in the former period (74% vs. 66%). It means that surgical treatment was more frequent in the years 2000 - 2001 (34% vs. 26%). However,the rate ofnephrectomy was significantly lower in the latter period: 73% vs. 42%. The time from injury to establishing diagnosis was shorter in the years 2000 -2001:222 rain vs.104 rain.
European Urology Supplements 4 (2005) No. 3, pp. 234
Liatsikos E. a, Kraniotis p.2, Siablis D. 1, Kagadis G. 3, Voudoukis T.4, Karnabatidis D. 2, Papathanasiou Z. 2, Barbalias G. a ~University Hospital of Patras, School of Medicine, Patras, Greece, 2University Hospital of Patras, Radiology, Patras, Greece, 3University of Patras, Medical Physics, Patras, Greece, 4University Hospital of Patras, Urology, Patras, Greece INTRODUCTION & OBJECTIVES: To evaluate the efficacy and safety of percutaneous nephrostomy and primary antegrade management for treating inadvertent iatrogenic ureteric injuries. MATERIAL & METHODS: We evaluated 10 patents who were referred for ureteric trauma after gynecologic surgery. All patients developed symptoms suggestive of ureteral obstruction sometime dunng the postoperative period ranging between 5 days to 1 week after surgery. A standard percutaneous nephrostomy route was obtained. Using a long 7 Fr sheath, a hydrophilic. 0035 guide wire was negotiated through the ureteral stricture with the aid of a hydrophilic-angled 5 Fr catheter. The hydropbilic guide wire was then exchanged with an Amplatz superstiff .0035 guide wire. The strictures were then gradually dilated with the use of high-pressure (20 Atm) angioplasty balloon to a maximum of 7 mm in diameter. The mean stricture length was 1.4 cm (range 0.4- 1.9cm). An antegrade ureteral 8 Fr pig tail stent was then inserted though the stricture. RESULTS: The initial technical success was 100%. There were no major complications concerning either the nephrostomy access itself or the subsequent ureteral manipulations. The mean follow-up period was 1 year. In 6 patients (60%) a patent ureter was noted at t week and ureteral stunt was removed, while 4 patients required repeat dilation of the stricture and stent reimplantation. Ureteral stents were removed in all patients after a mean period of 4.8 weeks. CONCLUSIONS: Percutaneous nephrostomy and primary antegrade ureteral balloon dilation is safe and efficacious for treating ureteral injury after pelvic surgery and obviates the need for open surgical manipulations.