Emergency management of renal and genitourinary trauma: best practices update.

Timing and Predictors for Urinary Drainage in Children with Expectantly Managed Grade IV Renal Trauma

Instituting a Conservative Management Protocol for Pediatric Blunt Renal Trauma: Evaluation of a Prospectively Maintained Patient Registry

Analysis of Diagnostic Angiography and Angioembolization in the Acute Management of Renal Trauma Using a National Data Set

Renal Trauma from Recreational Accidents Manifests Different Injury Patterns than Urban Renal Trauma

Mechanistic Relationship of All-terrain Vehicles and Pediatric Renal Trauma

Minimally Invasive Endovascular Techniques to Treat Acute Renal Hemorrhage

Genitourinary Injuries in Pediatric All-terrain Vehicle Trauma—A Mechanistic Relationship?

Severely injured patients with associated genitourinary (GU) injuries have only rarely been investigated in the current literature. If at all, analyses are commonly focussed on renal injuries, marginalising other GU traumas such as ureteral injuries. In this study, we would like to characterise patients with GU injuries and analyse the impact of such injuries on mortality and length of stay. The inclusion criteria for this retrospective analysis of TraumaRegister DGU® data were: Injury Severity Score ≥ 16 within the period between 2009 and 2016 with available data on age and length of stay. Adescriptive analysis was used to compare patients with and without GU injuries. The impact of GU injuries on mortality and length of hospital stay was evaluated by means of multivariate regression analyses. In all, 90,962patients met the inclusion criteria; 5.9% of them had suffered GU injuries (n = 5345). The prevalence in patients with pelvic fractures was up to 19%. On average, patients with GU trauma were 10years younger (42.9 vs. 52.2years) and more severely injured (ISS: 31.8 vs. 26.4). The multivariate analyses demonstrated that GU injuries in severely injured patients are no independent risk factor for mortality. However, particularly bladder and genital injuries result in longer hospitalisation. GU injuries do not represent an additional risk factor for mortality. However, after adjusting for established prognosis factors, they can cause prolonged periods of hospitalisation of severely injured patients.

Background: Management of renal trauma has evolved over past decades from surgical exploration to renal preservation. Conservative management of high-grade renal trauma is possible due to advancement in imaging modality, dedicated critical care and availability of selective embolization. The objective to this research was to analyze the demographics, characteristics and management of renal trauma in our institution. Methods: All patient who were admitted to College of Medical Sciences Teaching Hospital with diagnosis of renal trauma from 2017 to 2022 were retrospectively analyzed. Ethical approval was taken from institutional review committee of college of Medical Sciences. Data was collected from hospital medical records. Data was analyzed using descriptive statistical tools. For the categorical variable frequency and percentage was calculated while for continuous variables mean and standard deviation was calculated. Results: Sixty-three patients were included in this study and Median age of patient admitted with renal trauma was 31 years with male to female ratio of 7:3. Blunt renal trauma was the most common type (96.8 %) with Road traffic accidents responsible for the majority of mechanisms of injury 66.7% (42) followed by fall 11(17.5%). Majority of Renal trauma was in AAST Grade III 26(41.3%). Right sided renal injury was common 33 (52.4%) than left sided renal injury 30 (47.6%). Intervention was required in 9 patients. Conclusions: High-grade renal trauma can be managed conservatively in selected cases with close monitoring in critical care unit and with use of minimally invasive technique such as Selective angioembolization, Double J Ureteric stenting or Nephrostomy Insertion. But hemodynamically unstable patient after resuscitation warrants immediate surgical exploration.

Selective Management of Isolated and Nonisolated Grade IV Renal Injuries

Until recently, female U.S. service members (SMs) have not been permitted to serve in direct combat roles. However, during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), a large number of female SMs have been wounded while serving in combat support roles. This included an unprecedented number of women with genitourinary (GU) injuries. No previous studies have reported either the incidence or clinical picture of these injuries. The objective of this study is to describe the epidemiology of GU injuries among female U.S. SMs during OIF/OEF and understand the potential for increased female GU injuries in future conflicts and the long-term sequelae from these injury patterns. The Department of Defense Trauma Registry was reviewed to identify all U.S. SMs diagnosed with GU injury from 2001 to 2013. The Department of Defense Trauma Registry includes data for wounded SMs treated at any U.S. combat support hospital, the in-theater equivalent of a civilian trauma center. Female SMs with ICD-9-CM diagnosis codes and/or Abbreviated Injury Scale codes for GU injury were included. Data on all females with GU injury were reviewed, including battle injury (BI) and non-BI. Basic demographic and injury characteristics were reported. Among the 1,463 U.S. SMs diagnosed with GU injury while deployed to OIF/OEF, 20 (1.4%) were female (median age: 25 yr; interquartile range 21-27 yr). Of these, nine were BI (45%) and 11 were non-BI (55%). The distribution of injury location was as follows: renal injuries (n = 12), vulvar injuries (n = 3), vaginal injuries (n = 3), perineal injury (n = 1), and bladder injury (n = 1). Median Injury Severity Score was in the severe range of 21 (interquartile range 6-32), and four women (20%) died of their wounds. Important associated injuries included colorectal (n = 5) and lower extremity amputation(s) (n = 2). The most common mechanism of injury among the nine women with GU BI was improvised explosive device blast (n = 6), followed by other explosions (n = 2) and gunshot wound (n = 1). Mechanisms of GU non-BI varied, including gunshot wound (n = 2), fall (n = 2), fire/flame (n = 1), knife wound (n = 1), unintentional machine injury (n = 1), motor vehicle accident (n = 1), sports injury (n = 1), fight (n = 1), and pedestrian injury (n = 1). Female GU injuries comprise a small portion of all GU injuries sustained during OIF/OEF with the most predominant being renal injury. Now that the ground combat exclusion policy has been lifted, these data can be used as a model for the expected injury patterns in future female combatants. Long-term applications for these data include research and development for personal protective equipment and development of a multidisciplinary approach to long-term comprehensive care following GU trauma.

Genitourinary trauma is often overlooked in the setting of acute trauma. Usually other more life-threatening injuries take precedence for immediate management. When the patient is stabilized, radiologic imaging often plays a key role in diagnosing insults to the upper and lower genitourinary tract in the setting of trauma. Our aim is to provide a pictorial assay of imaging findings in upper and lower tract genitourinary trauma from a variety of mechanisms including blunt trauma, penetrating trauma, and iatrogenic trauma. A patient archiving and communication system will be used to review imaging studies of patients at our institution with genitourinary tract trauma. Cases of renal, ureteral, bladder, urethral, penile, and scrotal trauma will be considered for inclusion in our study. Multimodality imaging techniques will be reviewed. The imaging and pertinent findings that occur in various types of genitourinary trauma are outlined. Genitourinary trauma is often missed in the frenzy of acute trauma. It is important to have a high suspicion for injury especially in severe trauma, and in particular clinical settings. Although often not life threatening, recognizing the diagnostic imaging findings quickly is the realm of the astute radiologist so appropriate urologic management can be made.

Objective To study the management of severe blunt renal trauma in children. Methods From 2000 to 2008, clinical outcomes of 33 children with blunt renal trauma were retrospectively analyzed, especially focusing on the 15 severe blunt renal trauma cases (3 cases were hydronephrosis complicating with renal trauma).Results Neither deaths nor early nephrectomy was noted in this study. Eighteen patients with mild renal injury were cured after non operative management. Of the 15 severe cases, 8 were cured after conservative treatment, 3 with active bleeding were treated by selective renal artery embolization, and 1 with renal vascular injury underwent exploratory surgery and surgical repair of renovascular trauma; the other 3 were hydronephrosis complicating with renal trauma, of which 2 underwent pyloplasty and early postoperative drainage, and the last patient with renal failure and contralateral congenital renal atrophy underwent early post-injury nephrostomy and delayed pyloplasty to conserve more renal function. All severe cases have been followed-up for 5-28 months (mean follow-up duration: 18 months). One patient underwent nephrectomy of the atrophic kidney 6 months later for persistent secondary hypertension. Of the 4 cases complicated with urinary cysts, 1 underwent early ureteropelvic anastomosis, the other 3 underwent delayed urinary cysts resection.Conclusions Mild renal injury has a good prognosis after conservative treatment. The management of severe renal trauma should be based on specific clinical conditions of individuals. Early exploratory surgery and nephrectomy are not advocated on most severe renal trauma cases. The selective renal artery hemostatic embolization is a good option to stop active bleeding in blunt renal trauma patients. The severe renal trauma patients need close interval postoperative follow-up to prevent the complications such as urinary cyst and secondary hypertension. Key words: Renal trauma; Treatment; Children

Renal Trauma Classification and Management: Validating the Revised Renal Injury Grading Scale.

FR01-05 THE HISTORY OF GENITOURINARY BLAST TRAUMA