Management of renal injury in the Department of Urology at the University Hospital in Pilsen


Authors: Daniela Kovářová 1;  Jana Hlaváčová 1;  Olga Dolejšová 1;  Petr Stránský 1;  Jan Bulka 2;  Milan Hora 1
Authors‘ workplace: Urologická klinika LF UK a FN, Plzeň 1;  Radiodiagnostické oddělení LF UK a FN, Plzeň 2
Published in: Ces Urol 2013; 17(3): 166-174
Category: Original article

Overview

Aim:
We present a summary of our experiences and results with diagnostic algorithm and treatment of patients with renal injuries.

Methods:
A total of 172 patients with renal injury were treated at the Department of Urology in Pilsen between January 2005 and December 2012. We performed a retrospective analysis based on mechanism of injury, diagnostic algorithm used, significance of haematuria and choice of treatment. Iatrogenic injuries were excluded.

Results:
Non-penetrating renal trauma occurred in 170 patients (98.8%) and stab wounds in two cases (1.2%). According to the AAST (American Association for the Surgery of Trauma) classification of traumatic injury, minor injuries were the most frequent, (Grade I and II) which occurred in 128 cases (74%). Major injuries (Grade III–V) occurred in 46 patients (26%). Various degree of haematuria occurred in 83.8% of cases. Conservative management was used in 142 patients (81.6%). Twelve patients (6.9%) underwent surgical exploration with reconstruction and 20 patients (11.5%) underwent a nephrectomy.

Conclusion:
Non-penetrating, low-grade renal injury was found in the majority of cases. In some cases, hematuria was the only sign of renal trauma, although normal urinalysis did not completely excluded the injury. Computed tomography with intravenous contrast is the gold standard of imaging to evaluate patients with renal injury. In accordance with European standards, the conservative management aimed at preserving renal parenchyma was used preferentially.

Key words:
haematuria, renal injury, ultrasonography, computed tomography.


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Paediatric urologist Nephrology Urology
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