Wendler Johann J, Albert Christian, Cash Hannes, Meyer Frank, Pech Maciej, Schostak Martin, Mertens Peter R, Porsch Markus
University Clinic for Urology, Urooncology, Robot-Assisted and Focal Therapy, University Hospital Magdeburg A.ö.R., Medical Faculty of the Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany.
Urology Practice, 39104 Magdeburg, Germany.
J Clin Med. 2024 Sep 27;13(19):5765. doi: 10.3390/jcm13195765.
Blunt abdominopelvic trauma frequently results in injuries to the urinary organs, especially in polytrauma. The urotrauma is rarely an acute life-threatening event; however, it may lead to severe complications. This review addresses the under-representation of urological trauma management in interdisciplinary medical training and its impact on patient outcomes. It compiles evidence-based recommendations and guidelines from multiple specialties, focusing on common challenges in managing these injuries. The resource is tailored for primary care physicians in radiology, trauma surgery, internal medicine, urology, and nephrology. Urinary tract injuries can occur even if the patient's condition initially appears normal. An exclusion diagnosis is obligatory by contrast medium tomography of the entire urinary tract and, if suspected, an additional uroendoscopic examination. Interventional therapy by catheterisation of the urinary tract is often required. Urosurgical treatment is not commonly needed, but when there is a demand, it must be administered via an interdisciplinary approach with visceral and trauma surgery. Over 90% of life-threatening kidney injuries (usually up to grade 4-5 AAST) are presently treated by interventional radiologists. Acute kidney injury (AKI) as a complication in trauma patients may complicate clinical management and often worsens the outcome. The incidence of trauma-associated AKI in patients admitted to an intensive care unit is high. Patients suffering from blunt abdominopelvic trauma should ideally be referred to certified trauma centres with subspecialised or fully specialised care provided by visceral/vascular surgery, trauma surgery, interventional radiology, urology, and nephrology. This recommendation is based on the complex nature of most damage patterns.
钝性腹部盆腔创伤常导致泌尿器官损伤，在多发伤中尤为常见。泌尿创伤很少是急性危及生命的事件；然而，它可能导致严重并发症。本综述探讨了泌尿创伤管理在跨学科医学培训中的代表性不足及其对患者预后的影响。它汇集了多个专业基于证据的建议和指南，重点关注这些损伤管理中的常见挑战。该资源是为放射科、创伤外科、内科、泌尿外科和肾内科的初级保健医生量身定制的。即使患者最初情况看似正常，也可能发生尿路损伤。必须通过全尿路造影剂断层扫描进行排除诊断，如有怀疑，还需进行额外的尿内镜检查。通常需要通过尿路插管进行介入治疗。一般不需要进行泌尿外科手术，但有需求时，必须通过与内脏和创伤外科的跨学科方法进行。目前，超过90%的危及生命的肾损伤（通常高达美国创伤外科学会4 - 5级）由介入放射科医生治疗。创伤患者并发急性肾损伤（AKI）可能使临床管理复杂化，并常常使预后恶化。入住重症监护病房的患者中，创伤相关AKI的发生率很高。理想情况下，钝性腹部盆腔创伤患者应转诊至具备内脏/血管外科、创伤外科、介入放射科、泌尿外科和肾内科提供的亚专科或全专科护理的认证创伤中心。这一建议基于大多数损伤模式的复杂性。
