What specific urological imaging investigation should be requested for a stable patient following blunt abdominal trauma who has dipstick haematuria?
Jack McAninch’s data from the San Francisco General Hospital involved over 2000 patients with renal trauma at the time (1995) when it was recommended that stable patients with dipstick haematuria require no imaging. This was based on the findings that these patients very rarely had significant renal injuries and that in fact no significant injuries were missed in the non-imaged cohort of patients (1004). The accepted exception is a high index of suspicion of significant renal injury (e.g., fall from height and rapid deceleration injury). This is also supported by the EAU guidelines.
What is the imaging investigation of choice in a stable patient with suspected renal trauma who has presented with visible haematuria?
The early phase of the contrast CT scan will delineate any vascular and parenchymal injuries. The 10-minute delayed scan will identify contrast extravasation.
What is the difference between a Grade 3 and Grade 4 renal trauma injury?
The accepted staging classification for renal trauma was developed by the American Association for Surgery of Trauma (AAST) Organ Injury Scaling Committee. It has been validated by several studies and it correlates well with the need for kidney repair or removal.
When can penetrating injuries to the kidney be considered for non-operative management?
Operative exploration has traditionally been recommended for penetrating injuries. However, if a knife entry point is posterior to the anterior axillary line, then the likelihood of renal hilar injury or associated visceral injury is low. High-resolution CT is leading to an increase in the non-operative management of this patient group. Low-velocity gunshot wounds can also be managed non-operatively.
When should main renal arterial injury be repaired, if suspected to be injured?
Renovascular injuries are uncommon. Renal salvage following main renal artery injury occurs in a quarter of patients at best. Time to reperfusion is the major factor in determining outcome and therefore expeditious intervention is required.
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