OBJECTIVE To evaluate the clinical features and outcomes of patients who presented with grade IV renal trauma to our urban level I trauma hospital and to further refine the absolute indications for exploration and determine the outcomes of conservative management. PATIENTS AND METHODS In all, 77 patients with grade IV traumatic renal injuries presented to our emergency department between October 1997 and October 2006. A prospective trauma database including these patients was analysed to determine the patterns of injury, operative outcomes and complications. RESULTS A quarter of the patients had gunshot injuries, 9% had stab injuries, and 66% had blunt traumas. In all, 36% of patients required surgical exploration to treat associated non‐urological injuries. There was no or microscopic haematuria in 29% of the patients. Of the 32 patients who underwent renal exploration, 63% (20/32) underwent renorrhaphy and 37% (12/32) underwent nephrectomy. In multivariate analyses, only gunshot injury, surgery for non‐urological injury, and volume of blood transfused were significantly associated with the need for renal exploration (P = 0.015, P = 0.041, and P = 0.032, respectively). The renal complication rate was higher in patients managed conservatively vs those who underwent surgical exploration, but this was not statistically significantly different (28% vs 13%, P = 0.2). Hospital stay was longer after renal exploration than after conservative management at a median of 12 days vs 7 days (P = 0.01). CONCLUSIONS While almost all patients with penetrating injury require renal exploration, only 20% of those with blunt trauma do. Patients with no renal injuries and/or haemodynamic instability are more likely to require exploration. Finally, the rate of complications was not statistically different according to management type (conservative vs renal exploration).
Skills training on a LAP Mentor VR simulator improved VR surgical performance. Before incorporating this simulator into resident education, the LAP Mentor will have to undergo testing for predictive and construct validity.
Surgical skills acquired as a result of training on a virtual reality laparoscopic simulator are not procedure specific but improve overall surgical skills, thereby translating into superior performance of an unrelated live laparoscopic urological procedure.
Background: Although the American Association of the Surgery for Trauma Organ Injury Scale is the gold standard for staging renal trauma, it does not address characteristics of perirenal hematomas that may indicate significant hemorrhage. Angiographic embolization has become well established as an effective method for achieving hemostasis. We evaluated two novel radiographic indicators-perirenal hematoma size and intravascular contrast extravasation (ICE)-to test their association with subsequent angiographic embolization. Methods: Among 194 patients with renal trauma between 1999 and 2004, 52 having a grade 3 (n = 33) or grade 4 (n = 19) renal laceration were identified. Computed tomography scans were reviewed by a staff radiologist and urologist blinded to outcomes. ICE was defined as contrast within the perirenal hematoma during the portal venous phase having signal density matching contrast in the renal artery. Hematoma size was determined in four ways: hematoma area (HA), hematoma to kidney area ratio (HKR), difference between hematoma and kidney area (HKD), and perirenal hematoma rim distance (PRD). Results: Of the 52 patients, 8 had ICE and 4 of these (50%) required embolization, whereas none of the 42 (0%) patients without ICE needed embolization (p = 0.001). Likewise, all four measures of perirenal hematoma size assessed were significantly greater in patients receiving embolization [HA (128.3 vs. 75.4 cm, p = 0.009), HKR (2.75 vs. 1.65, p = 0.008), HKD (76.5 vs. 30.2 cm, p = 0.006), and PRD (4.0 vs. 2.5 cm, p = 0.041)]. Conclusion: Perirenal hematoma size and ICE are readily detectible radiographic features and are associated with the need for angiographic embolization.
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