GuidelinesReview of the Current Management of Upper Urinary Tract Injuries by the EAU Trauma Guidelines Panel
Introduction
This paper is a comprehensive review of the current methods of diagnosis and treatment of injuries to the upper urinary tract (kidney and ureter). Iatrogenic injuries were covered fully in a previous publication by this group [1] and thus are excluded from this paper.
Section snippets
Evidence acquisition
The panel reviewed the English-language literature via a Medline search (publication dates up to December 2013) with the focus on newer publications, although some older key references are included. A full version of the latest European Association of Urology (EAU) guidelines on the management of urologic trauma is available in print [1] and online (www.uroweb.org).
Incidence and aetiology
Renal injuries occur in 1–5% of all trauma cases and are classified as blunt (90–95% in rural settings) or penetrating (40% in urban settings) [2]. The kidney is the most commonly injured genitourinary organ at all ages, with a male:female ratio of 3:1 [3]. Mechanisms include road traffic accidents (about 50%), falls (16%), sports (direct blow to the flank or abdomen), and assault. Sudden deceleration or a crash injury may result in contusion and laceration of the parenchyma and/or collecting
Conclusions
It can be seen that the main cause of renal injury is blunt trauma, and the best method of diagnosing and classifying the extent of the injury is by CT scanning. In almost all renal injuries, the mainstay of treatment is conservative if the patient is stable. Selective angioembolisation is recommended as a technique to stop bleeding and achieve salvage of viable renal tissue, in the absence of any indications for immediate open exploration.
Noniatrogenic ureteral injuries are rare and are most
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2022, European Urology FocusCitation Excerpt :The use of nonoperative management (NOM) has significantly increased over the past decades with the improvement of imaging, the development of endourology, and the introduction of interventional radiology [3,4]. NOM is now regarded as the treatment of choice for all hemodynamically stable patients with renal trauma [5–8]. Angiography with selective angioembolization (SAE) is safe and effective for addressing bleeding in patients with renal trauma, and SAE indications have thus expanded over the past 10 yr [9,10].