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To determine the optimal evaluation and management of renal injuries by review of the world's English-language literature on the subject

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(Received Prostate brachytherapy involves implanting radioactive seeds (I 125 for instance) permanently in the gland for the treatment of localized prostate cancers e.g. cT1c-T2a N0 M0 with good prognostic factors. Treatment planning and seed implanting are most often based on the intensive use of transrectal ultrasound (TRUS) imaging. This is not easy because prostate visualization is difficult in this imaging modality particularly as regards the apex of the gland and from an intra-and inter-observer variability standpoint. Radioactive seeds are implanted inside open interventional MR machines in some centres. Since MRI was shown to be sensitive and specific for prostate imaging whilst open MR is prohibitive for most centres and makes surgical procedures very complex, this work suggests bringing the MR virtually in the operating room with MRI/TRUS data fusion. This involves providing the physician with bi-modality images (TRUS plus MRI) intended to improve treatment planning from the data registration stage. The paper describes the method developed and implemented in the PROCUR system. Results are reported for a phantom and first series of patients. Phantom experiments helped characterize the accuracy of the process. Patient experiments have shown that using MRI data linked with TRUS data improves TRUS image segmentation especially regarding the apex and base of the prostate. This may significantly modify prostate volume definition and have an impact on treatment planning.

Nonoperative management can and should be performed safely in cases of grade IV injuries whenever possible, with valuable long-term renal function. It can also be initiated in grade V cases. However, surgeons should consider nephrectomy with the onset of any suspicious symptoms.