A Clinical Guide to Urologic Emergencies (eBook)

Hunter Wessells, Shigeo Horie, Reynaldo G. Gómez (Herausgeber)

eBook Download: EPUB

2021
John Wiley & Sons (Verlag)
9781119021490 (ISBN)

Infos

A Clinical Guide to Urologic Emergencies

A Clinical Guide to Urologic Emergencies

An ageing population and a predicted shortfall in the number of urologists means that, increasingly, the management of complex urological problems will fall to hospital emergency departments and the surgeries of primary care physicians. With many doctors and medical students now having less exposure to urology, there is a real and urgent need for accessible and practical guidance in managing urologic emergencies.

A Clinical Guide to Urologic Emergencies offers practical guidance to the best practices in diagnosis, treatment and management of patients with urgent urological conditions. Designed to be an extremely useful tool to consult in the clinical setting, it will be a vital source of information and guidance for all clinicians, irrespective of their level of urologic knowledge.

Edited by an outstanding international editor team, this book is particularly aimed at physicians, advanced practice providers, and urology and emergency medicine trainees managing patients in diverse healthcare settings across the globe.

A Clinical Guide to Urologic Emergencies is accompanied by a website featuring video content at www.wiley.com/go/wessells/urologic

The Editors

Hunter Wessells, MD, FACS, is Professor and Nelson Chair of Urology in the Department of Urology at the University of Washington School of Medicine, Seattle, WA, USA.

Shigeo Horie, MD, PhD, is Professor and Chairman in the Department of Urology at Juntendo University Graduate School of Medicine, Tokyo, Japan

Reynaldo G. Gómez, MD, FACS, is Chief of Urology at the Hospital del Trabajador, Santiago, Chile.

Inhalt

Contributors

Preface

SECTION 1 Upper Urinary Tract

1 Blunt Renal Injuries

Lindsay Hampson and Nnenaya Mmonu

2 Penetrating Renal Trauma - A Civilian and Military Perspective

Jonathan Wingate

3 Renal Infections

Brusabhanu Nayak, Nitin Srivastava, and Rajeev Kumar

4 Acute Kidney Stone Management

Justin S. Ahn and Jonathan D. Harper

5 Traumatic Adrenal Hemorrhage

Hong Truong and Bradley D. Figler

6 External Ureteral Trauma

Humberto G. Villarreal and Steven J. Hudak

7 Iatrogenic Ureteral injury

Haruaki Kato, Kazuyoshi Iijima, Tomohiko Oguchi, Seiji Yano

SECTION 2 Lower Urinary Tract

8 Bladder Injuries

Yosuke Nakajima

9 TRAUMATIC URETHRAL INJURIES

Laura G. Velarde and Reynaldo G. Gómez

10 Acute management of urethral stricture

Akio Horiguchi

11 PROSTATITIS AND PROSTATIC ABSCESS

Hunter Wessells

SECTION 3 External Genitalia

12 Fournier's Gangrene

Kosuke Kitamura and Shigeo Horie

13 Traumatic Penile Injuries

Ariel Fredrick and Alex J. Vann

14 Priapism

Akash A. Kapadia, Kevin Ostrowski and Thomas J. Walsh

15 Traumatic Scrotal and Testicular Injuries

Marios Hadjipavlou and Davendra Sharm

16 Testicular Torsion

Alexander J. Skokan and Dana A. Weiss

17 Epididymitis and Orchitis

Norman Zambrano

SECTION 4 Pediatric

18 Urologic Neonatal Emergencies

Nicolas Fernandez and Nayib Fakih

Index

Textauszug

1
Blunt Renal Injuries

Lindsay A. Hampson and Nnenaya Mmonu

Department of Urology, UCSF School of Medicine, San Francisco, CA, USA

Epidemiology, Etiology, Pathophysiology

Epidemiology and Etiology

Kidneys are the most injured genitourinary organ in external trauma, and it is estimated that 1–5% of all traumas and 10% of abdominal traumas sustain a renal injury [1–4]. In a series consisting purely of blunt abdominal trauma mechanism, 15% of patients were found to have an injury to the kidneys [5]. Of all patients who sustain genitourinary trauma, over half of them involve the kidney [6]. A population‐based study found the incidence of renal trauma to be 4.9 per 100 000 population ≥16 years of age in the United States [4]. The majority of these patients were young and male, with 72% between the ages of 16 and 44 and 75% male. In an analysis of pediatric genitourinary injuries, renal injuries were found to make up 3.5% of the cohort, but the incidence has not been defined [7].

There is variation in the etiology of renal trauma based on geographical location; series from Low and Middle‐Income Countries (LMIC) suggest that the rates of penetrating trauma are high, with the majority of blunt trauma caused by road traffic accidents, assault, and falls [8–11]. In the More Economically Developed Countries (MEDC), the vast majority (90–95%) of renal injury is sustained by blunt trauma, which is caused by motor vehicle collisions (63%), falls (14%), sports injuries (11%), pedestrian accidents (4%), motorcycle crashes (2%), assault (2%), and the remaining from other causes [6, 12, 13]. In a recent blunt renal trauma series, 80% of injuries were found to be grade I–II renal injuries, 9.5% grade III, 8.1% grade IV, and 2.7% grade IV [5]. Thus, imaging all renal injuries is unnecessary, and criteria have been developed (see below). Table 1.1 summarizes the large (n > 100) series with emphasis on blunt injuries.

Table 1.1 Demographics of renal trauma.

SERIES a	[6]	[14]	[15]	[1] b	[4]	[16]	[5] b	[17]	[18]	[19]

Year published

1984

1986

1995

2001

2003

2012

2012

2013

2013

2014

Renal injury (N)

154

132

2254

227

6231

1505

221

338

9002

105

Renal injury (%)

2.9

3.25

n/a

1.4

1.2

n/a

n/a

n/a

n/a

n/a

Blunt (%)

93.5

95.4

89.8

93.4

81.6

95.0

100

96.2

82.0

96.1

Penetrating (%)

6.5

4.6

10.2

6.6

18.4

5.0

0

3.9

17.8

3.9

Grade IV–V (%)

n/a

14.6

10.9

29.3

21.1

23.5

Initial non‐operative management among all trauma (%)

92.6

92.6

n/a

88.6

94.5

n/a

92.6

86.8

98.0

Initial non‐operative management among blunt trauma (%)

98.3

89.5/92.9?

96.3

92.3

92.6

94.4

Nephrectomy (%) among all trauma

3.8

3.2

7.9

3.1

n/a

7.1

8.6

1.9

Nephrectomy (%) among blunt trauma

0

7.2

3.3

5.4

7.4

4.7

Blank cells indicate missing data.

a Series with N < 100 not included.

b Data showing grade and management of blunt renal injuries only.

Pathophysiology

Blunt trauma injury to the kidney is thought to occur as a result of kinetic energy transmission, often as a consequence of rapid deceleration forces or direct interaction of structures in the environment with the soft tissues and bones of the flank and then the kidney. Studies using animal models have shown that the kidney has viscoelastic properties and that damage occurs as a result of stresses that cause tissue deformations exceeding an impact energy threshold of 4 J [20, 21]. A three‐dimensional animal model also demonstrated that the primary site of load‐bearing, where injuries result from, is the junction between the renal pelvis and the renal cortex [21]. Research has also demonstrated that the kidney with a fluid‐filled structure (i.e. ureteropelvic junction obstruction, hydronephrosis, or renal cyst) may be more prone to rupture due to the hydrostatic pressure and resulting distribution of forces within the kidney [20, 22].

Children may have a higher risk of significant renal injury from blunt trauma and this is thought to be related to the proportionately larger kidney for their body size as compared to that of adults, the possibility of children retaining fetal lobulations that may predispose to parenchymal disruption, and the pediatric kidney having less protection due to lower perirenal fat content, weaker abdominal muscles, and less ossification of the rib cage [23, 24].

The proportion of patients with renal trauma found to have congenital anomalies varies, depending on different series, ranging from 1 to 23% [23]. One series that reviewed 193 pediatric renal trauma patients found that just over 8% of patients had a congenital anomaly [25]. Data regarding renal trauma and congenital anomalies is somewhat mixed, with most studies suggesting that congenital anomalies increase the risk of significant renal injury and decrease the possibility of renal salvage, while other series suggest that there is no effect on morbidity or mortality [25-30]. Overall consensus is that pre‐existing renal anomalies likely increase the vulnerability of kidneys in blunt renal trauma [4, 30]. They may also complicate the management of a renal laceration involving the collecting system or parenchyma (e.g. horseshoe kidney with complex arterial vasculature, UPJ (ureteropelvic junction) obstruction, etc.).

Diagnosis

Workup

A complete history, including the crash mechanics and velocity of impact as well as known pre‐existing renal disease or abnormality, should be obtained if possible. For example, renal injury frontal and side impact collisions may be impacted by direct contact from seatbelt and steering column [31]. Seatbelt use and airbag deployment are also important characteristics to note; absence of a seatbelt is associated with higher probability of thoracoabdominal injury [32]. Compared to individuals who did not have airbag deployment with vehicle collision, those with frontal and side airbags have a 46 and 53% decrease in renal injury, respectively [33]. Vehicle characteristics are important given the association of increased crash test rating (i.e. safer car) with lower likelihood of thoracoabdominal injury [32].

Blunt trauma caused by a blow to the flank, rib fracture, or rapid deceleration injury should make clinicians suspicious for possible renal injury. Such mechanisms include injuries related to sports (in particular ice hockey, soccer, and football), ski and snowboarding, and motor vehicle versus pedestrian. Signs of renal injury from blunt trauma that may be noted on physical examination include gross hematuria, flank hematoma, and abdominal or flank tenderness. Vital signs are important to obtain and monitor both in the field and upon arrival at the hospital, as hemodynamic stability drives evaluation and management of renal trauma. Laboratory examinations, including a creatinine, hematocrit, and urinalysis with microscopic analysis to evaluate for hematuria, should be obtained.

Radiographic Evaluation

The American Urological Association (AUA) has released guidelines to provide indications for imaging of suspected renal trauma [34]. Patients sustaining blunt injury that require diagnostic imaging are those who have gross hematuria, or those who have a systolic blood pressure of less than 90 mmHg with microscopic hematuria. Additionally, any patients who are stable but have a mechanism of injury (e.g. fall from a great height) or physical examination (see above) findings concerning renal injury should also be imaged, as trauma patients may have renal injury, even in the absence of hematuria or shock...

Produkt-Details

• Erscheint lt. Verlag: 6.5.2021
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Urologie
• Schlagworte: Medical Science • Medizin • Notfallmedizin • Urologie • Urology
• ISBN-13: 9781119021490 / 9781119021490