Elsevier

European Urology

Volume 67, Issue 5, May 2015, Pages 930-936
European Urology

Guidelines
Review of the Current Management of Upper Urinary Tract Injuries by the EAU Trauma Guidelines Panel

https://doi.org/10.1016/j.eururo.2014.12.034Get rights and content

Abstract

Context

The most recent European Association of Urology (EAU) guidelines on urological trauma were published in 2014.

Objective

To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment.

Evidence acquisition

The EAU trauma guidelines panel reviewed literature by a Medline search on upper urinary tract injuries; publication dates up to December 2013 were accepted. The focus was on newer publications and reviews, although older key references could be included.

Evidence synthesis

A full version of the guidelines is available in print and online. Blunt trauma is the main cause of renal injuries. The preferred diagnostic modality of renal trauma is computed tomography (CT) scan. Conservative management is the best approach in stable patients. Angiography and selective embolisation are the first-line treatments. Surgical exploration is primarily for the control of haemorrhage (which may necessitate nephrectomy) and renal salvage. Urinary extravasation is managed with endourologic or percutaneous techniques. Complications may require additional imaging or interventions. Follow-up is focused on renal function and blood pressure. Penetrating trauma is the main cause of noniatrogenic ureteral injuries. The diagnosis is often made by CT scanning or at laparotomy, and the mainstay of treatment is open repair. The type of repair depends upon the severity and location of the injury.

Conclusions

Renal injuries are best managed conservatively or with minimally invasive techniques. Preservation of renal units is feasible in most cases. This review, performed by the EAU trauma guidelines panel, summarises the current management of upper urinary tract injuries.

Patient summary

Patients with trauma benefit from being accurately diagnosed and treated appropriately, according to the nature and severity of their injury.

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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