La patologia traumatica del rene: Nostra esperienza in tema di stadiazione e di indicazione chirurgica: Renai trauma: Our experience in clinical staging and surgical treatment

Abstract

We studied in retrospect 144 patients suffering from blunt trauma of the kidney in order to better define the indications for radiological assessment and surgical treatment. If staging is fundamental, most of ail for high-risk patients, it is our opinion that urography must still be considered the decisive X-ray test to assess the renal parenchyma and the urinary tract of the kidney as well as the integrity of the adelph. In cases with micro hematuria and in absence of shock, ultrasound diagnosis is used in place of urography, whereas computerized tomography of the abdomen must be restricted to the cases of renal autoamputation, urohematic extravasation and suspected intraperitoneal injuries. We adopt conservative treatment for all those injuries to the renal parenchyma which respect the urinary tract, whereas we recommend emergency surgical treatment in those cases involving traumatism of the pedicle or kidney fragmentation. We instead postpone surgical treatment in all other cases, following spontaneous haemostasis of the renal space. We believe that both the rate of death and invalidating consequences from traumatic pathology of the kidney can be significantly reduced where there is qualified pre-hospital assistance and cooperation with a medical facility offering rapid detailed diagnosis and specific medicosurgical treatment.