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Renal trauma in the previously injured kidney
Serafetinides E., Ploumides A., Mourmouras N., Garaganis G., Pavlakis P., Kariotis I., Melides P., Delakas D.
Asclepeion Voulas, Dept. of Urology, Athens, Greece
INTRODUCTION & OBJECTIVES: Renal injuries are either iatrogenic or result from external violence. Patients with a history of renal surgeryor trauma are believed to be more prone to a second injury. To analysethe incidence and natural history of these injuries, a retrospective studywas made from 1990 to 2010.
MATERIAL & METHODS: We evaluated 962 renal trauma patients(720 males, 242 females; mean age 45.8±9.5 years; range 22 to 80 years) according to age, gender, type and grade of trauma (III - V), accompanying other organ injuries, radiological imaging findings, andtreatment. Outcomes were compared between renal trauma patientswho had a history of kidney injury or surgery (Group A) and those whodid not (Group B). All patients had a CT scan upon admission. Renaltrauma grade was assessed using the guidelines developed by theAmerican Association for the Surgery of Trauma’s Organ Injury Scaling Committee. Measures of outcome included need for exploration,kidney salvage, perinephric abscess, urinoma, delayed nephrectomyor hemorrhage, and hypertension.
RESULTS: A total of 37 (3.8%) patients with history of renal injuries (Group A) were identified. Reliable history was obtained from allpatients. Injury severity distribution was 22 grade III, 4 grade IV, and11 grade V. Thirty five injuries occurred as a consequence of motorvehicle accidents and falls, with the remainder occurring as result ofpenetrating trauma (stab wounds). In 24 patients past renal injurieswere iatrogenic (9 pyeloplasties, 10 partial nephrectomies, 5nephrolithotomies). Thirteen patients had a past blunt minor renalinjury (grade II – III). In general, the groups were not different withregard to epidemiologic characteristics, radiological findings, and InjurySeverity Score. In group A there was a higher incidence of grade V
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injuries and subsequent nephrectomies. In both groups the patientshad similar clinical course (early and late complications).
CONCLUSIONS: Our data suggests that trauma in the previously injured kidney is rare. Although the sample is small, the clinical courseof these patients seems to be similar with those with previously healthykidneys. A higher incidence of grade V injuries and nephrectomies wasnoted, especially in patients with a history of open operations of thekidney.
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