[Renal trauma. Treatment strategies and indications for surgical exploration].
Most renal injuries are blunt, involve a young patient population, and are caused by motor vehicle accidents or sport injuries. Renal trauma is classified into five grades with the majority of injuries being minor. CT scan has become the standard investigation method and should be performed in blunt trauma with macroscopic hematuria. Open trauma requires a radiological work-up in all forms of hematuria and in cases of clinical suspicion due to the wound entrance. Treatment management of most injuries has become conservative. Absolute indications for surgical revision are persistent life-threatening bleeding, renal pedicle injuries as well as an expanding, pulsatile retroperitoneal hematoma. Indications become relative in the presence of large devitalized renal tissue with urinary extravasation and other abdominal injuries, particularly of the pancreas and the colon. Surgical revision is more often indicated in open trauma, but surgery should enable renal reconstruction in the majority of cases.
Clinique d'Urologie, Département de Chirurgie, Hôpital Universitaire, Genève. f-schmidlin@bluewin.ch
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D000063:Accidents, Traffic; D001265:Athletic Injuries / Q000175:diagnosis / Q000601:surgery; D003952:Diagnostic Imaging; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000293:injuries*; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D009392:Nephrectomy; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery*