Kidney and uro-trauma: WSES-AAST guidelines
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(2019) 14:54
REVIEW
Open Access
Kidney and uro-trauma: WSES-AAST guidelines Federico Coccolini1*, Ernest E. Moore2, Yoram Kluger3, Walter Biffl4, Ari Leppaniemi5, Yosuke Matsumura6, Fernando Kim7, Andrew B. Peitzman8, Gustavo P. Fraga9, Massimo Sartelli10, Luca Ansaloni11, Goran Augustin12, Andrew Kirkpatrick13, Fikri Abu-Zidan14, Imitiaz Wani15, Dieter Weber16, Emmanouil Pikoulis17, Martha Larrea18, Catherine Arvieux19, Vassil Manchev20, Viktor Reva21, Raul Coimbra22, Vladimir Khokha23, Alain Chichom Mefire24, Carlos Ordonez25, Massimo Chiarugi1, Fernando Machado26, Boris Sakakushev27, Junichi Matsumoto28, Ron Maier29, Isidoro di Carlo30, Fausto Catena31 and WSES-AAST Expert Panel
Abstract Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines. Keywords: Kidney, Urogenital, Urethra, Ureter, Bladder, Trauma, Adult, Pediatric, Classification, Guidelines, Embolization, Surgery, Operative, Non-operative, Conservative, Stenting, Urological, Endovascular trauma management, Flow chart
Background In both, adult and children cohorts, urogenital trauma has a cumulative incidence of 10-20%, and the kidney is involved in 65–90% of the time [1–3]. Males are involved 3 times more than females (both in adults and children) [2, 4]. As in other abdominal injuries, the use of non-operative management (NOM) has significantly increased in last decades, particularly due to the introduction of hybrid rooms and endovascular trauma and bleeding management (EVTM) associated with modern urological mini-invasive procedures [5, 6]. Moreover, In pediatric patients, NOM should be the first option as soon as it is viable and safe. However, operative management (OM) remains the gold standard in unstable patients, after failure of NOM (fNOM), and in many * Correspondence: [email protected] 1 General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy Full list of author information is available at the end of the article
injuries caused by penetrating mechanisms; in fact, in gunshot and stab wounds, OM is applied in 75% and 50% of cases, respectively [1]. As for the other abdominopelvic lesion management, decisions should be based on physiology, anatomy, and associated injuries [6–9]. Another important consideration relates to the different manag
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