The role of IVP in blunt trauma

Review of the evidence on the management of blunt renal trauma in pediatric patients

Due to the size and location within the pediatric patient, the kidneys are susceptible to injury from blunt trauma. While it is clear that the goal of management of blunt renal trauma in children is renal preservation, the methods of achieving this goal have not been well established in the current literature. Therefore, we have set out to summarize and clarify the current published information on the management strategies for blunt renal trauma in children. While there is extensive literature available, it consists mostly of retrospective series documenting widely varied management styles. The purpose of this review is to display the current information available and delineate the role for future studies that may allow us to develop consistent management strategies of pediatric patients, who have sustained blunt renal trauma, in a safe and cost-effective manner.

The role of CT in the management of adult urinary tract trauma

Computed tomography (CT) is now the investigation of choice for evaluating haematuria following major abdominal trauma. This pictorial review provides a logical framework for understanding the classification and features of urinary tract injuries, defines the indications and outlines the techniques for CT imaging in upper and lower urinary tract trauma. The use of other competing imaging modalities is also discussed.

Correlation between urinalysis and intravenous pyelography in pediatric abdominal trauma

Controversy exists surrounding the appropriate indications for intravenous pyelography (IVP) in assessing blunt renal injuries in children. Forty-one consecutive cases of suspected blunt renal injuries, who had an IVP performed between January 1988 and December 1990 at The Children's Hospital of Eastern Ontario, were examined by a retrospective chart review. Eighty percent of the IVPs were normal. Of the eight abnormal IVPs, four were contusions, two lacerations, and two nontraumatic abnormalities. There was no hemodynamic compromise, no requirement for surgical intervention, and no deaths in the study population. In the absence of significant hematuria (> or = 100 rbc/hpf), the probability of detecting a traumatic abnormality on IVP is low (4%). There was no correlation between the mechanism of injury and the IVP findings. We conclude that intravenous pyelography has a low yield in the absence of significant hematuria (> or = 100 rbc/hpf).

Urinary tract injuries in multiply-injured patients: a rational guideline for the initial assessment

In a retrospective study involving 866 multiply-injured patients we demonstrated urinary tract injuries in 72 patients (8.3 per cent), 17 (2 per cent) of which were serious. Haematuria was a frequent finding in multiply-injured patients. In patients with serious lesions of the urinary tract, more than 35 RBCs/HPF in the sediment or macroscopic haematuria were found. All major injuries were demonstrated by the emergency intravenous urogram. Ultrasonography demonstrated contusions of the kidney or bladder and ruptures of the kidneys, but was not reliable in diagnosing ruptures of the bladder. Of 155 patients with a pelvic fracture 13 (8 per cent) had lower urinary tract injuries. In all these patients the fracture was located in the pubic arch. If a retrograde urethrogram was performed in these patients all urethral lesions were detected. We propose a rational guideline, which guarantees diagnostic accuracy of serious injuries of the urinary tract after blunt trauma, while interfering as little as possible with the resuscitative and diagnostic procedures in severely injured patients.

Urinary tract injury in patients with blunt chest trauma: the value of postaortographic abdominal radiographs

Patients who require thoracic aortography for blunt decelerating chest trauma often sustain injury to other organ systems due to the magnitude and mechanism of injury. Hospital records and radiographs of 117 consecutive, injured patients studied with thoracic aortography were evaluated to assess the accuracy, value, and limitations of postaortographic abdominal plain radiography for detection of major genitourinary injury. In summary, major urinary tract injury occurred with a frequency of 6%, enough to justify a rapid, low cost, noninvasive screening procedure. Postaortographic plain films of the abdomen were found to be an accurate (95%) screen for detection of major urinary tract injury. The sensitivity for detection of patients with renal injury was 100%. The ability to correctly predict patients who may be safely observed (no significant renal injury) was 100%. One limitation of this technique was the poor diagnostic quality found in 15% of the abdominal radiographs, most commonly caused by excessive superimposed bowel gas. Postaortographic pelvic radiographs were believed to be valuable for detection, but not exclusion, of bladder rupture.