Our clinical approach to patients with renal trauma

Yıl 2019, Cilt: 12 Sayı: 2, 195 - 201, 30.08.2019

Serhan Çimen Ayla Özaydoğdu Çimen

https://doi.org/10.26559/mersinsbd.456707

Öz

Objective: In this study, our clinical approach to
patients with renal trauma is evaluated. Method:
Retrospective analysis was made for the data of 182 patients who applied to and
were monitored and treated at Malatya Training and Research Hospital between
2014-2018 for isolated renal trauma. Demographic characteristics such as age
and gender, the ways of injury, vital findings at first diagnosis, treatment
method and complication data were collected for the patients. Grading of the
renal trauma was performed based on the organ injury scale of the American
Association for the Surgery of Trauma. Results: The mean age of the
patients diagnosed with renal trauma was found as 32.4 year (18-68 year). 151
of these patients (82.9%) were male and 31 (17.1%) of them were women. When the
ways of injury were examined, it was found that 55 (30.2%) patients had
penetrating injuries and 127 (69.8%) of them had blunt injuries. The
distribution of renal trauma according to the American Association for the
Surgery of Trauma organ injury scale was 64, 62, 41, 12 and 3 for Grade
1-2-3-4-5 injuries respectively. 170 patients underwent conservative treatment.
The average duration of hospital stay for the patients was found to be 7.08 (4-12) days. Conclusion:
Conservative treatment should be attempted primarily in all patients with renal
injury and hemodynamic stability.

Böbrek travması olan hastalarda klinik yaklaşımımız

Öz

Amaç: Bu çalışmamızda böbrek
travması olan hastalara klinik yaklaşımımız değerlendirildi. Yöntem: 2014-2018 yılları arasında
Malatya Eğitim ve Araştırma Hastanesi Acil Servisi’ne travma nedeniyle başvuran
hastalarda tespit edilen izole böbrek travması tanısı ile takip ve tedavi
edilen 182 hastanın verileri retrospektif olarak incelendi. Hastaların yaş,
cinsiyet gibi demografik özellikleri, yaralanma şekilleri, ilk tanı anındaki
vital bulguları, tedavi metotları ve gelişen komplikasyon verileri toplandı.
Böbrek travmasının derecelendirilmesi Amerikan Travma Cerrahi Birliği’nin organ
yaralanma şiddeti ölçeğine göre yapıldı. Bulgular:
Renal travma tanısı konulan hastaların yaş ortalaması 32,4 yıl (18-68 yıl) idi.
Bu hastaların 151’i (%82,9) erkek iken, 31’i (%17,1) kadındı. Yaralanma
şekilleri değerlendirildiğinde 55 (%30,2) hastada penetran yaralanma ve 127 (%
69,8) hastada künt yaralanma olduğu görüldü. Böbrek travmalarının Amerikan
Travma Cerrahi Birliği organ yaralanması skalasına göre dağılımının Grade
1-2-3-4-5 yaralanmalar için sırasıyla 64, 62, 41, 12 ve 3 olduğu tespit
edildi.  Hastaların 170’ inde konservatif
tedavi uygulandı. Hastaların ortalama hastanede kalış süresi 7,08 (4-12) gün
olarak bulundu. Sonuç: Böbrek
yaralanması olan ve hemodinamisi stabil olan hastaların hepsinde öncelikli
olarak konservatif tedavi yaklaşımı denenmelidir.

Anahtar Kelimeler

Böbrek, Travma, Nefrektomi, Konservatif Tedavi

Kaynakça

• 1. Özkürkçügil C, Ayan S, Uçar C, Gültekin Y. Kliniğimizde görülen ürogenital travmaların genel özellikleri. Ulus Travma Acil Cerrahi Derg 1997;3(3):218-221. 2. Kaya C, Koca O, Kalkan S, Öztürk M, İlktaç A, Karaman Mİ. Evaluation of patients with urogenital trauma managed in a urology clinic. Ulus Travma Acil Cerrahi Derg 2009;15(1):67-70. 3. Büyükçam F, Şen J, Akpınar Ş, Zengin Y, Çalık M, Odabaş Ö. Evaluation of urogenital injuries in patients with trauma in the Emergency Department. Ulus Travma Acil Cerrahi Derg 2012;18(2):133-140.4. Taviloğlu K, Ertekin C. Current status and future options for trauma and emergency surgery in Turkey. Ulus Travma Acil Cerrahi Derg 2008;14:10-13.5. Baverstock R, Simons R, McLoughlin M. Severe blunt böbrek trauma: a 7-year retrospective review from a provincial trauma centre. Can J Urol 2001;8(5):1372-13766. Meng MV, Brandes SB, McAninch JW. Böbrek trauma: indications and techniques for surgical exploration. World J Urol 1999;17(2):71-77.7. Peterson NE. Genitourinary trauma. In: Feliciano DV, Moore EE, Mattox KL, editors. Trauma. 3rd edition. Stanford, CT: Appleton and Lange; 1996. p. 661-93.8. Palmer LS, Rosenbaum RR, Gershbaum MD, Kreutzer ER. Penetrating ureteral trauma at an urban trauma center: 10- year experience. Urology 1999;54(1):34-36.9. Sangthong B, Demetriades D, Martin M, et al. Management and hospital outcomes of blunt böbrek artery injuries: analysis of 517 patients from the National Trauma Data Bank. J Am Coll Surg 2006 Nov;203(5):612-617. 10. Kuvel M, Aydemir H, Balaban M, Göktaş C, Albayrak S. How should urologic approach be to renal trauma? Turkish Journal of Urology 2009;35(1):38-42.11. Wessells H, Suh D, Porter JR, Rivara F, MacKenzie EJ, Jurkovich GJ, et al. Renal injury and operative management in the United States: results of a population- based study. J Trauma 2003;54(3):423-430.12. Kawashima A, Sandler CM, Corl FM, et al. Imaging of renal trauma: a comprehensive review. Radiographics 2001;21(3): 557-574.13. Brown SL, Hoffman DM, Spirnak JP. Limitations of routine spiral computerized tomography in the evaluation of blunt renal trauma. J Urol 1998;160(6):1979-1981.14. Hurtuk M, Reed RL 2nd, Esposito TJ, et al. Trauma surgeons practice what they preach. The NTDB story on solid organ injury management. J Trauma 2006;61(2):243-254.15. Santucci RA, Fisher MB. The literature increasingly supports expectant (conservative) management of böbrek trauma-a systematic review. J Trauma 2005;59(2):493-503.16. Santucci RA, McAninch JW. Diagnosis and management of böbrek trauma: past, present, and future. J Am Coll Surg 2000;191(4):443-451.17. Gedik A, Gedik E, Deliktaş H, Şahin H, Bircan K. Blunt and penetrating renal injuries: 18-year experience. Turkish Journal of Urology 2009;35(1):43-48.18. Tuğcu V, Şahin S, Özbay B, Baş M, Karadağ S, Aras B, Taşçı Aİ. Böbrek Yaralanması Olan Hastalarda Klinik Yaklaşımımız. Bakırköy Tıp Dergisi 2006;2(3):97-10019. Sagalowsky AI, McConnell JD, Peters PC. Renal trauma requiring surgery: an analysis of 185 cases. J Trauma 1983; 23(2): 128-131.20. Lanchon C, Fiard G, Arnoux V, et al. .High Grade Blunt Renal Trauma: Predictors of Surgery and Long-Term Outcomes of Conservative Management. A Prospective Single Center Study. J Urol 2016;195(1):106-111.21. Velmahos GC, Demetriades D,Cornwell EE 3rd, et al. Selective management of renal gunshot wounds. Br J Surg 1998;85(8):1121-1124.22. el Khader K, Mhidia A, Ziade J, Patard JJ, Guille F, Lobel B. Conservative treatment of stage III kidney injuries. Acta Urol Belg 1998;66(4):25-28.23. Santucci RA, McAninch JM. Grade IV renal injuries: evaluation, treatment, and outcome. World J Surg 2001;25(12):1565-1572.24. D.J. Summerton (Chair), N. Djakovic, N.D. Kitrey et all. Guidelines on Urological Trauma 2015.25. Santucci RA, Wessells H, Bartsch G et all. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int 2004;93(7):937–954.26. Heyns CF. Renal trauma: indications for imaging and surgical exploration. BJU Int 2004; 93(8): 1165–1170.27. McAninch JW, Carroll PR, Klosterman PW, Dixon CM, Greenblatt MN. Renal reconstruction after injury. J Urol 1991;145(5):932-937.28. Altman AL, Haas C, Dinchman KH, Spirnak JP. Selective nonoperative management of blunt grade 5 renal injury. J Urol 2000;164(1):27-30.29. Malcolm JB1, Derweesh IH, Mehrazin R et all. Nonoperative management of blunt renal trauma: is routine early follow-up imaging necessary? BMC Urol. 2008(3);8-11. 30. Shoobridge, Matthew F. Bultitude, Jim Koukounaras et all. A 9-year experience of renal injury at an Australian level 1 trauma centre Jennifer J. BJU Int 2013;112(2):53–60.31. Lebech A, Strange-Vognsen HH. Hypertension following blunt kidney injury. UgeskrLaeger 1990; 152(14): 994-997.32. Wang KT, Hou CJ, Hsieh JJ, Chou YS, Tsai CH. Late development of renal arteriovenous fistula following gunshot trauma-a case report. Angiology 1998;49:415-418.33. Miller DC, Forauer A, Faerber GJ. Successful angioembolization of renal artery pseudoaneurysms after blunt abdominal trauma. Urology 2002;59(3):444.