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Review
. 2019 Dec 2:14:54.
doi: 10.1186/s13017-019-0274-x. eCollection 2019.

Kidney and uro-trauma: WSES-AAST guidelines

Federico Coccolini  1 , Ernest E Moore  2 , Yoram Kluger  3 , Walter Biffl  4 , Ari Leppaniemi  5 , Yosuke Matsumura  6 , Fernando Kim  7 , Andrew B Peitzman  8 , Gustavo P Fraga  9 , Massimo Sartelli  10 , Luca Ansaloni  11 , Goran Augustin  12 , Andrew Kirkpatrick  13 , Fikri Abu-Zidan  14 , Imitiaz Wani  15 , Dieter Weber  16 , Emmanouil Pikoulis  17 , Martha Larrea  18 , Catherine Arvieux  19 , Vassil Manchev  20 , Viktor Reva  21 , Raul Coimbra  22 , Vladimir Khokha  23 , Alain Chichom Mefire  24 , Carlos Ordonez  25 , Massimo Chiarugi  1 , Fernando Machado  26 , Boris Sakakushev  27 , Junichi Matsumoto  28 , Ron Maier  29 , Isidoro di Carlo  30 , Fausto Catena  31 ; WSES-AAST Expert Panel
Collaborators, Affiliations
Review

Kidney and uro-trauma: WSES-AAST guidelines

Federico Coccolini et al. World J Emerg Surg. .

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: Adult; Bladder; Classification; Conservative; Embolization; Endovascular trauma management; Flow chart; Guidelines; Kidney; Non-operative; Operative; Pediatric; Stenting; Surgery; Trauma; Ureter; Urethra; Urogenital; Urological.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests. (*: NOM should only be attempted in centers capable of a precise diagnosis of the severity of kidney injuries and capable of intensive management (close clinical observation and hemodynamic monitoring in a high dependency/intensive care environment, including serial clinical examination and laboratory assay, with immediate access to diagnostics, interventional radiology and surgery and immediately available access to blood and blood products or alternatively in presence of a rapid centralization system in those patients amenable to be transferred; @: Hemodynamic instability in adults is considered the condition in which patient has an admission systolic blood pressure < 90 mmHg with evidence of skin vasoconstriction (cool, clammy, decreased capillary refill), altered level of consciousness and/or shortness of breath, or > 90 mmHg but requiring bolus infusions/transfusions and/or vasopressor drugs and/or admission base excess (BE) >-5 mmol/l and/or shock index > 1 and/or transfusion requirement of at least 4-6 Units of packed red blood cells within the first 24 h; moreover transient responder patients (those showing an initial response to adequate fluid resuscitation, and then signs of ongoing loss and perfusion deficits) and more in general those responding to therapy but not amenable of sufficient stabilization to be undergone to interventional radiology treatments. In pediatric patients: Hemodynamic stability is considered systolic blood pressure of 90 mmHg plus twice the child’s age in years (the lower limit is inferior to 70 mmHg plus twice the child’s age in years, or inferior to 50 mmHg in some studies), Stabilized or acceptable hemodynamic status is considered in children with a positive response to fluids resuscitation: 3 boluses of 20 mL/kg of crystalloid replacement should be administered before blood replacement; positive response can be indicated by the heart rate reduction, the sensorium clearing, the return of peripheral pulses and normal skin color, an increase in blood pressure and urinary output, and an increase in warmth of extremity. Clinical judgment is fundamental in evaluating children.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
AAST organ injury scale for kidney trauma
Fig. 3
Fig. 3
Kidney trauma management algorithm
Fig. 4
Fig. 4
Uro-trauma management algorithm
See this image and copyright information in PMC

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