S.L. Brown, DM Hoffman, J.P., Spirnak, (Case Western Reserve Univ, Cleveland, Ohio)
Limitations of Routine Spiral Computerized Tomography in the Evaluation of Blunt Renal Trauma.
J Urol 160:1979-1981, 1998.
In 3 of 35 patients (8.6%) spiral computerized tomography failed to identify injuries to the collecting system. In all 3 cases, injuries were detected on repeating the study over a period of several days based on high clinical suspicion.
This delay between scans, gives the contrast material sufficient time to image the collecting system and it ensures accurate staging and appropriate treatment of the renal injury.
NA Armenakas, CP Duckett, JW McAnunch (Univ of California, San Francisco)
Indications for Non-operative Management of Renal Stab Wounds.
J Urol. 161: 768-771, 1999.
More than half of all stab wounds to the kidney can be selectively treated non-operatively. Non-operative approach was selected in 108 of 199 (54%) cases.
Patients without haemodynamic instability or clinical signs suggestive of peritonitis should undergo clinical, laboratory or radiological investigations (CT Scan or IVU) to stage the injury.
An overall renal salvage rate of 94.5% can be obtained. Adequate staging with a CT scan is imperative.
G.C. Velmahos, E Degiannis. (Univ of Southern California, Los Angeles, Univ of Witwatersrand, Johanesburg S. Africa) – The Management of Urinary Tract Injuries after Gunshot Wounds of the Anterior and Posterior Abdominal Wall.
Injury : 28, 535-538, 1997.
If radiological staging of the renal injury has been obtained preoperatively ( a rare occurrence) and shows an injury remote from the pedicle without urinary extravasation, then observation may be a reasonable option in a stable patient.
In patients with stable perirenal haematoma remote from the hilum noted at the time of exploration for associated intra-abdominal injury, non-operative management of the genitourinary tract is associated with few complications.
Meticulous exploration of all periureteral haemotomas in the absence of haematuria is needed.