Читать книгу A Clinical Guide to Urologic Emergencies - Группа авторов - Страница 25

Renal trauma may be incompletely staged and this can be an important determinant for renal exploration. If exploration occurs before complete staging has been accomplished, a one‐shot IVP or retrograde pyelograms can be performed in the operating room (see above), or the kidney and/or ureters can be directly inspected during an abdominal exploration [79].

In cases of renal trauma, it is important to have familiarity with damage control maneuvers. It is particularly important in patients who do not have life‐threatening renal injury. In cases of uncontrolled bleeding, vascular control is paramount. Renal pedicle access by blunt dissection over psoas fascia allows for application of a large vascular clamp. Once this is done, then the kidney can be evaluated and nephron sparing techniques can be applied. Another consideration is in cases where the patient is unstable for kidney exploration and repair in the setting of active bleeding. In this case, packing the renal fossa with delated intervention is an alternative to nephrectomy. This would allow for appropriate staging in patients who were initially unstable for imaging. This staging may allow for the patient to have non‐operative management and/or angioembolization.