Renal Trauma

Serafetinides, E.

doi:10.1007/978-3-540-48605-3_18

Cited by 2 publications

(1 citation statement)

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“…As NSS generally results in a pattern of injuries analogous to grade III-IV renal trauma, according to the American Association for the Surgery of Trauma Organ Injury Severity Scale [12,13], a conservative approach should be the first choice. This controlled bleeding successfully in six of 15 cases, while all other patients underwent TAE or surgery.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo identify risk factors for relevant haemorrhage after open nephron‐sparing surgery (NSS) for renal cell carcinoma, and to evaluate its clinical management.PATIENTS AND METHODSWe evaluated bleeding complications after open NSS in 196 consecutive cases (193 patients) at our institution. The median (range) age of the patients was 64 (3–91) years and the tumour diameter was 2.7 (0.5–11.8) cm. Sex, age, body mass index, imperative vs elective indication, year of surgery, multifocality, tumour diameter and malignant vs benign pathology were tested exploratively and significant variables entered in a multivariate model. The clinical management of haemorrhage after NSS was analysed.RESULTSBleeding required conservative (six), interventional (six) or surgical (three) therapy in 15 of the 196 cases (8%). Imperative indication (P= 0.043) and multifocality (P= 0.039) were independent risk factors in a multivariate model. Compared with superselective percutaneous transarterial embolization (TAE), surgery as a primary therapeutic option was more likely within 24 h after NSS (P= 0.012). Bleeding was finally controlled in all patients, while the kidney was preserved in 11 patients. There was only a minor decline of renal function at the 3‐month follow‐up.CONCLUSIONSWe identified multifocal tumours and imperative indication as risk factors for haemorrhage after NSS. The management was very successful, relying on TAE as an effective and safe treatment for bleeding after NSS. In rare cases of severe bleeding surgical exploration is unavoidable, with a lower chance of kidney preservation.

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Section: Discussionmentioning

confidence: 99%

Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

et al. 2010

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Nierentrauma

Pfitzenmaier

Buse

Haferkamp

et al. 2008

Urologe

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Most renal injuries in industrialized countries are caused by blunt trauma to the kidney. The management of renal trauma has always been and will always be controversial. Conservative management and aggressive intervention both have their proponents, but conservative treatment is generally favored nowadays, even in the case of grade IV/(V) trauma. Urinary diversion by nephrostomy tube or ureteral stenting is not mandatory in most cases because the extravasation resolves in up to 90% of cases. Overall, there is a tendency toward a multimodal approach in which the interventional radiologist is more and more often part of the team that takes care of the patient with high-grade injuries. The success rate of angioembolization is 70-80%. Long-term consequences can be hypertension or diminished kidney function.

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Renal Trauma

Cited by 2 publications

References 462 publications

Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

Nierentrauma

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