University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

43

Pages:

2
Author:

Mariam A.

Evaluation and management of injuries of the kidney and ureter Evaluation: 1. History and Physical Examination: o A thorough history should be obtained, including the mechanism of injury, presence of associated symptoms such as hematuria, flank pain, or abdominal trauma, and any relevant medical or surgical history. o Physical examination may reveal signs of abdominal trauma, including tenderness, bruising, or palpable masses. 2. Imaging Studies: o Imaging modalities such as CT scan, ultrasound, or MRI are commonly used to assess the extent and severity of kidney and ureteral injuries. o Contrast-enhanced CT scan is the preferred imaging modality for evaluating traumatic injuries, providing detailed anatomical information and identifying associated injuries to adjacent structures. o Ultrasound may be used as an initial screening tool, particularly in hemodynamically unstable patients, to detect free fluid or parenchymal abnormalities. o MRI is useful for assessing renal vascular injuries and avoiding radiation exposure, especially in pregnant patients or those with contraindications to CT. 3. Laboratory Tests: o Urinalysis is essential for evaluating hematuria, which is a common finding in kidney and ureteral injuries. o Serum electrolytes, renal function tests, and complete blood count may be ordered to assess for associated injuries or complications. Management: 1. Conservative Management: o Minor kidney or ureteral injuries may be managed conservatively with observation, bed rest, analgesia, and close monitoring for resolution of symptoms and signs of complications. o Nonoperative management is typically reserved for stable patients with small, nonexpanding perinephric hematomas or minor ureteral injuries. 2. Surgical Intervention: o Surgical intervention is indicated for significant or expanding perinephric hematomas, renal vascular injuries, urinary extravasation, or ureteral injuries causing obstruction. o Surgical options include exploratory laparotomy, nephrectomy, nephroscopy, ureteral reimplantation, or ureteral stenting to relieve obstruction and restore urinary drainage. 3. Iatrogenic Causes: o Iatrogenic injuries to the kidney and ureter can occur during surgical procedures involving the retroperitoneal or pelvic regions, such as:  Nephrectomy or partial nephrectomy: Inadvertent injury to the renal vessels, collecting system, or surrounding structures.  Ureteroscopy or cystoscopy: Trauma to the ureter during instrument manipulation or passage of instruments, leading to ureteral perforation or stricture formation.  Percutaneous nephrostomy or ureteral stenting: Accidental injury to adjacent structures or misplacement of catheters. o Prompt recognition and management of iatrogenic injuries are essential to minimize morbidity and prevent long-term complications. 4. Follow-Up: o Close follow-up evaluations are necessary to monitor for resolution of symptoms, assess renal function, and detect any delayed complications such as urinary fistula, stricture formation, or chronic kidney disease. o Imaging studies may be repeated to evaluate for resolution of hematoma or healing of injured structures.