Editing Upper Urinary Tract Trauma (section)

==== <span style="color:#ff0000">Surgical management</span> ====
*Nephrectomy is a frequent result when hemodynamically unstable patients undergo surgical exploration
*'''<span style="color:#ff0000">Approach: transabdominal</span>'''
**'''Allows complete inspection of intra-abdominal organs and bowel.'''
*'''<span style="color:#ff0000">Principles of renal reconstruction after trauma include (8):</span>'''
*#'''Complete renal exposure'''
*#'''Measures for temporary vascular control'''
*#*'''<span style="color:#ff0000">Isolate the renal vessels before exploration</span> to provide the immediate capability to occlude them if massive bleeding should ensue when the Gerota fascia is opened'''
*#'''Limited debridement of nonviable tissue'''
*#'''Hemostasis by individual suture ligation of bleeding vessels'''
*#'''Watertight closure of the collecting system if necessary/possible'''
*#'''Reapproximation of the parenchymal defect'''
*#'''Coverage with nearby fascioadipose flaps (Gerota fascia or omentum) if feasible'''
*#*The open parenchyma should be covered when possible by a pedicle flap of omentum. The rich vascular and lymphatic supply of the omentum promotes wound healing and decreases the risk for delayed bleeding and urinary extravasation.
*#'''Liberal use of drains'''
*'''<span style="color:#ff0000">For major renovascular injuries in patients with 2 kidneys, speedy nephrectomy is advocated</span>'''
**In rare instances in which vascular repair is technically feasible, renal salvage rates are disappointingly low
*'''<span style="color:#ff0000">In damage control surgery, the area around the injured kidney is packed with laparotomy pads to control bleeding, with a planned return in approximately 24 hours to explore and evaluate the extent of injury.</span>'''
**This allows the cold, acidotic, and coagulopathic patient to be stabilized in the ICU before any attempt at potentially lengthy renal reconstruction is attempted.
*'''<span style="color:#ff0000">In an unstable patient, if damage control is not an option, total nephrectomy would be indicated immediately when the patient’s life would be threatened by attempted renal repair.</span>'''