Introduction. Blunt renal trauma is the most common urologic disturbance. For the last 2 decades, the number of renal trauma decreases: from 1-8% to 0,4%-1,07%. Men are more vulnerable than women. Usually patients are of working age and the trauma is caused with traffic accident or fall from a height. In cases of 4-5th grade of renal trauma (according OIS classification) multiple abdominal organ`s disturbances are revealed in 64,3-90,6% patients. It leads to the fact that surgery is often performed by abdominal surgeon holding another operative opinion than urologist. Nowadays, expectant approach in 1-3 OIS grade of renal trauma is common. On the other hand, no consensus is achieved in treatment strategy of 4-5 OIS grade patients. Purpose of the work: to determine the frequency of kidney injury in patients with closed abdominal trauma, to identify patients with severe injuries among patients with kidney injury, to compare the treatment tactics of this category of patients before and after the appearance of the urological service at the N.V. Sklifosovsky Institution. Material and methods. Retrospective study of 187 patients with blunt abdominal trauma was performed during the period of 2016-2019. In 32,6% cases multiple disturbance including kidney was detected. Male persons were more common (73,8%), age 18-72 (37,9±8,83), usually suffered road traffic accident (57,4%) or height fall (31,1%). Stable patients (ISS<16) were 67,2%, unstable (ISS≥16) – 32,8%. The severity of renal disturbance was appreciated with CT in 67,2% case and after laparotomy in others. Treatment strategy was defined by urologists in 5 patients with OIS grade 3-5 and by general surgeons in 15 patients. Results. In «urology» group laparotomy and renal exploration was done in 1(20%) person, embolization of renal artery branch was performed in 2(40%) and non-operative management was chosen for 2(40,0%) patients with sufficient outcome. Hospital stay amounted to 13,7±2,4 days. All patients of «general surgery» group underwent laparotomy. Among them paranephric hematoma was explored in 2(13,4%), nephrorrhaphy was done in 3(20,0%) and nephrectomy – in 10(66.6%) injured ones. Hospital discharge on 17,5±3,5 day. Discussion. All patients with renal trauma met abdominal organs disturbances too. Urologists in these cases are more prone to expectant strategy than general surgeons while less aggressive (expectant and angiosurgery) approach demonstrates better outcomes. Conclusion. In case of similar grade of renal trauma expectant approach and angioembolisation save the patient from open surgery in 80% cases, facilitates early activation and shorten hospital stay significantly. In view of paucity of such cases in our review following studies are expected.

Introduction. Еven though open bladder suturing is a traditional method of surgical treatment of intraperitoneal rupture of the bladder, laparoscopic bladder suturing is a prospective method for treating such injuries. Materials and methods. In N.V. Sklifosovsky Research Institute of Emergency Care during the period from January 2016 to April 2020, 22 patients with bladder injury were treated. 15 of them had an intraperitoneal rupture, 5 had an extraperitoneal rupture, and 2 had a bladder rupture. Among the affected men there were 15 (68%), women - 7 (32%), the average age of patients was 42 ± 18 years. The clinical picture was dominated by gross hematuria and pain in the lower abdomen. All patients underwent ultrasound examination (US) according to the FAST protocol, and cystography was performed in some patients. Results. 20 (91%) patients were operated and 2 (9%), with extraperitoneal rupture of the bladder, were drained by urethral catheters. Patients were divided by the method of surgical treatment into 2 groups. In the 1st group, 2 (10%) patients underwent laparoscopic suturing of the bladder with drainage of the bladder with a urethral catheter. 18 (90%) patients of the 2nd group underwent laparotomy with suturing of the bladder. Depending on the method of bladder drainage, patients were divided into the cystostomy group (group A) and the urethral catheter group (group B). Group A - 16 (73%) patients who underwent laparotomy, suturing a rupture or ruptures of the bladder, epicystostomy, drainage of the abdominal cavity and lower pelvis. Group B-4 (18%) patients after laparotomy, laparoscopy, as well as patients who underwent conservative therapy with the installation of an urethral catheter – 2 (9%). Discussion. In the world literature, there are few scientific articles on the laparoscopic method of treating bladder injury, and the presented works are based on a small sample of patients. But, despite this, the method seems to be a promising and effective method for treatment and can be used in patients with intraperitoneal rupture of the bladder with stable hemodynamics, without life-threatening concomitant injuries. Conclusion. Тhe use of open or laparoscopic suturing of the bladder without epicycostomy significantly reduces the hospital stay and allows to restore natural urination on average 7 days after surgery. Laparoscopic suturing of the bladder is an effective and alternative treatment for bladder rupture.