Urogenital Trauma

Abstract

limitation since is not an easy task, but allows an accuracy of 67% in patients with grade 4 (possible cancer) and accuracy of 79% in patients presenting at least one voxel grade 5 (cancer is definite present).Although the author's conclusion is that addition of MRSI to MRI alone does not significantly improve the diagnostic accuracy for prostate cancer detection they also concluded that MRI and MRSI might still serve as a useful supplement to endorectal sonographically guided biopsy on an individual basis. A repeat biopsy could target regions that show an abnormality on MRI and MRSI to help improve the diagnostic yield of endorectal sonographically guided biopsy, as we have previously shown. Purpose: Urinary extravasation is a common finding in grade 4 and 5 renal injuries. To date there has been little written about the natural course of urinary extravasation following renal trauma. We reviewed data on the outcomes of urinary extravasation in the traumatized kidney when managed nonoperatively. Materials and Methods: A retrospective review of the prospectively entered urological trauma database from San Francisco General Hospital was performed from 1979 to 2005. All patients with urinary extravasation after sustaining traumatic injury to the kidney as seen on computerized tomography were included in analysis. Results: A total of 61 patients with urinary extravasation were identified. Of these patients 27 (44%) were treated operatively (26 of 27 underwent immediate and 1 of 27 underwent delayed open surgery). All (100%) operatively treated patients underwent renal exploration and repair at primary surgical management of associated abdominal and/or vascular injuries. Open surgical exploration resulted in nephrectomy in 5 of 27 (19%) patients. Of the 34 (56%) patients treated nonoperatively only 3 (9%) had persistent, nonprogressing urinary extravasation by computerized tomography 3 to 7 days after injury. All 3 (100%) of these patients underwent uncomplicated endoscopic ureteral stent placement followed by complete resolution of urinary extravasation. Conclusions: Nonoperative management of urinary extravasation in patients sustaining traumatic injury to the kidney without associated abdominal or vascular injury is safe and results in resolution in more than 90%. In patients with persistent urinary leakage endoscopic ureteral stent placement may be needed and is successful.