Pathology

Abstract

been applied to all organ system, including genitourinary. Although as urologists, we are in the kidney preservation business, the overall survival of the patient should not be compromised in order to save the kidney. In other words, do not kill the patient trying to save the kidney. In trauma circles, the way to damage control injures organs is to quickly control bleeding and fecal and urinary soiling. To control bleeding the organ can be packed, quickly repaired or removed. To control urinary spillage, the ureter can be exteriorized, ligated or quickly repaired. The use of damage control to urology was popularized (1). To the trauma surgeons, since most trauma patients are young healthy adults with 2 normal kidneys and a normal creatinine, the kidney can be removed without too much overall kidney function compromise. Velmahos et al., puts up a good argument in the above article, but I would argue a different conclusion. The authors are trying to support the high 50-60% nephrectomy rates of yester-year. I would argue that the nephrectomy rate does not have to be higher the 20% and we can still follow a damage control method. Furthermore, palpating for a normal feeling contralateral kidney can be unreliable. I have personally seen 2 cases of trauma patients with a nonfunctioning contralateral multi-cystic dysplastic kidney and one hypertrophied psoas muscle that was thought to be palpably normal kidney by the trauma service. In the stable blunt trauma patient, all grade 1-4 renal injuries should managed conservatively if possible. In the blunt trauma patient who is explored, a stable, nonpulsatile, nonexpanding, contained perinephric hematoma should be left alone. In the penetrating trauma patient who is explored and the kidney does not have much blast injury and not really bleeding, I would just cover the gunshot holes with a surgi-cell and place a drain. The kidney can also be packed. Once resuscitated on a staged celiotomy, the kidney can be reexamined and a more definitive repair can be performed.