930Angiography and embolization: A technique for nonoperative management of significant (grade II through IV) blunt renal trauma

929

930

THE EXPRESSION OF BETA-2 M I C R O G L O B U L I N IN U R I N A R Y SAMPLE IN CORRELATION TO RENAL INJURY

ANGIOGRAPHY

AND

NONOPERATIVE

M A N A G E M E N T OF SIGNIFICANT

Lekas A?, Fokitis I. 1, Lefakis G. 1, Maniotis W. 1 : Fragos C. 2, Koritsiadis S. 1

THROUGH IV) BLUNT RENAL TRAUMA

1General Hospital of Nikea, Urology, Pireaus, Greece, 2General Hospital of Nikea, Biochemical and Hormonal Laboratory, Pireaus, Greece

G1entzes V. 1, Martinis S?, Tsanis A. 2, Pomoni M. 2, Aggelidis E 1, Stathis H / ,

INTRODUCTION & OBJECTIVES: Renal trauma occurs in approximately 1-5 % of all traumas. Beta -2 Microglobuling ([32M) has been identified as the light chain of HLA-A, -B and - C major histocompatibility complex antigens. High rates of urinary [32M are interpreted as evidence of tubular dysfunction. The purpose of this study is to correlate (32M with the renal trauma. As we lonow this is the first study that correlates the [32M with the renal injury.

Athens, Greece

EMBOLIZATION:

A

TECHNIQUE

FOR

(GRADE II

Poulias I. 1 1Red Cross Hospital, Urology, Athens, Greece, 2Red Cross Hospital, Radiology,

INTRODUCTION & OBJECTIVES: To present our experience in the nonoperative management of blunt renal trauma, using angiography and

MATERIAL & METHODS: During the period from 01/01/04 to 01/10/04, 30 patients suffering of renal injury (Grade I-IV), were hospitalized in the department of urology of our hospital. All patients underwent clinical and laboratory tests as well as radiological control (abdominal ultrasound or double contrast abdominal CT scan). [32M urinary excretion levels were measured in 25 patients, on the day of injury, the 1st and on the 7th day of hospitalization. The 5 patients that were excluded suffered of multiple conditions affecting 132M urinary levels. The control group consisted of 5 healthy patients without any pathological condition. RESULTS: All patients presented with high urinary excretion of f52M on the day of injury and the day after with levels ranging from 585ng/mI to 17141ng/ml (N.P.< 300 ng/ml). The greater the severity of renal injury, the higher the levels of [32M urinary excretion. On the 7'h day of hospitalization, these 132M levels showed particular descendance (ranging from 7.8 ng/ml to 298 ng/ml) and in all of the causes were normalized. All patients of the control group presented with normal [32M measures in the urinary sample. CONCLUSIONS: [52M urinary levels is a reliable marker for renal injury, significantly useful in cases that in radiological control does not reveal any renal injm2¢ and the suspicion is set by the injury mechanism and micro - or macroscopic hematuria.

931 RETROSPECTIVE ANALYSIS OF 157 RENAL TRAUMA CASES Akay A.F. i, Aflay U. 1, Ydmaz G. 2, Akay H. i, ~ahin H. 1, Bircan K. 1 1Dicle University, Urology, Diyarbaklr, Turkey, 2Dicle University, General Surgery, Diyarbaklr, Turkey INTRODUCTION & OBJECTIVES: We reviewed our renal trauma cases and discussed our diagnosis and treatment modalities. MATERIAL & METHODS: 157 patients with renal injuries who had been hospitalised in Urology and General Surgery clinics between 1990-2004 were rewired retrospectively. Patients were evaluated with regard to age, sex, cause of trauma, transport time, diagnostic methods, grade of injuries, associated organ injuries, treatments and complications. RESULTS: 163 renal injuries were established in 157 patients. The patients were between 4 and 65 years old; 129 (82.16 %) were male and 28 (17.84%) were female. The most common cause of injuries (111 patients) was penetrating injuries. The transport time to hospital after injuries was approximately 127 minutes. Immediate laparotomy was performed in 107 hemodynamically unstable patients. Radiological investigations were carried out in the remaining 50 patients. Most of injuries were grade 4 (37, 23.56%) or 5(63, 40.12%). Isolated renal injury was established in only 27 of 157 patients. Nephrorraphy was performed in 46 of 163 kidneys. 29 injured kidneys were managed conservatively. Nephrectomy was performed in 79 of 163 kidneys. 30 patients were lost intraoperatively or during the early postoperative period. CONCLUSIONS: Were think that our rates of nephrectomy and mortality were high because of the long transport time, unsuitable transport type, and frequent high grade and high rate of associated organ injuries.

embolization. MATERIAL & METHODS: Over a period of 21 months, 11 cases of significant (grade II through IV) blunt renal trauma were managed with angiography and embolization. All cases were carefully selected and staged with spiral CT scanning, 10 minutes after contrast injection. RESULTS: 8 patients responded exceptionally to the procedure and gross hematuria was cleared within 24 hours, permitting early ambulation and hospital discharge after 7 days. 2 patients developed recurrence of gross hematuria and bed rest was reinstated for 5 and 6 days respectively and 1 patient was managed operatively (nephrectomy), due to persistent renal bleeding and expanding perirenal hematoma. CONCLUSIONS: Angiography and embolization is a safe and effective method of treating significant blunt renal trauma, providing that great care is taken in accurate staging and patient selection.

932 COMMON DIAGNOSTIC AND THERAPEUTIC PITFALLS IN THE PRIMARY EVALUATION OF GENITOURINARY TRAUMA Mitsogiannis I. 1, Serafetinides E. 2, Stravodimos K. 2, Mitropoulos D. 2, Giannopoulos A. 2 1University Hospital of Larissa, Department of Urology, Larissa, Greece, 2University Hospital of Athens, Department of Urology, Athens, Greece INTRODUCTION & OBJECTIVES: Genitourinary injuries (GUI) account for less than 20% of all trauma patients. The initial evaluation of GUI patients is usually carried out by General Practitioners and/or General Surgeons. The aim of this study was to highlight common mistakes made during the initial evaluation of GU injuries. MATERIAL & METHODS: The records of all patients admitted with genitourinary trauma to our Institution over a 5-year period were reviewed. A panel of Urologists experienced in trauma management analysed the files of 174 consecutive cases and evaluated all data recorded throughout their primary evaluation. RESULTS: Incomplete history documentation as well as inadequate radiographic evaluation was the commonest pitfalls during the diagnostic process in the Emergency Department. A repeat CT scan had to be carried out in 9 patients initially submitted to a non contrast-enhanced CT scan and this resulted in delayed diagnosis. Inadequate physical examination was performed in 6 patients whereas significant radiographic findings were missed in 3 cases. In 14 cases, a nonindicated urethral catheterisation was attempted. The urgent management of penetrating abdominal injuries resulted in overlooking of 4 concomitant blunt renal injuries. The data showed that the diagnostic pitfalls were associated with a high Injury Severity Score (ISS). CONCLUSIONS: Overconfidence and the presence of life threatening injuries may lead to diagnostic and therapeutic errors during evaluation of GUI patients which result in increased morbidity and a high reoperation rate. Strict application of trauma management protocols, continuous education and timely consultation may reduce the frequency of errors. Scrotal and renal injuries are more prone to be missed whereas urethral catheterisation is the most common therapeutic attempt leading to complications.

European Urology Supplements 4 (2005) No. 3, pp. 235