Upper Urinary Tract Trauma: Difference between revisions

Line 296:

=== Management ===

* Based on hemodynamic stability If hemodynamically stable: Traumatic ureteral lacerations should be repaired immediately A longitudinal laceration is converted into a transverse one so as not to narrow the ureteral lumen (Heineke-Mikulicz procedure)

** '''Based on hemodynamic stability'''

* If hemodynamically unstable: temporary urinary drainage followed by delayed definitive repair Options for temporary urinary drainage (4): Ureteral stent (internalized double J or exteriorized single J) only

*** '''If hemodynamically stable:'''

* Short period of observation with a plan for reoperation when the patient is more stable, usually within 24 hours

**** '''Traumatic ureteral lacerations should be repaired immediately'''

* Exteriorize the ureter

***** '''A longitudinal laceration is converted into a transverse one''' '''so as not to narrow the ureteral lumen (Heineke-Mikulicz procedure)'''

* Tie off the ureter (with long silk sutures for easy identification at time of delayed repair) and plan percutaneous nephrostomy

*** '''If hemodynamically unstable: temporary urinary drainage followed by delayed definitive repair'''

* Definitive repair of the injury should be performed when patient has improved/stabilized

**** '''Options for temporary urinary drainage (4):'''

****# '''Ureteral stent''' (internalized double J or exteriorized single J) '''only'''

****# '''Short period of observation with a plan for reoperation when the patient is more stable, usually within 24 hours'''

****# '''Exteriorize the ureter'''

****# '''Tie off the ureter''' (with long silk sutures for easy identification at time of delayed repair) '''and plan percutaneous nephrostomy'''

***** Definitive repair of the injury should be performed when patient has improved/stabilized

*

* Special scenarios Ureteral contusion Options, depending on ureteral viability and clinical scenario (2): Ureteral stenting

* Resection with primary repair

@@ Line 296: / Line 296: @@
 === Management ===
-* Based on hemodynamic stability If hemodynamically stable: Traumatic ureteral lacerations should be repaired immediately A longitudinal laceration is converted into a transverse one so as not to narrow the ureteral lumen (Heineke-Mikulicz procedure)
+** '''Based on hemodynamic stability'''
-* If hemodynamically unstable: temporary urinary drainage followed by delayed definitive repair Options for temporary urinary drainage (4): Ureteral stent (internalized double J or exteriorized single J) only
+*** '''If hemodynamically stable:'''
-* Short period of observation with a plan for reoperation when the patient is more stable, usually within 24 hours
+**** '''Traumatic ureteral lacerations should be repaired immediately'''
-* Exteriorize the ureter
+***** '''A longitudinal laceration is converted into a transverse one''' '''so as not to narrow the ureteral lumen (Heineke-Mikulicz procedure)'''
-* Tie off the ureter (with long silk sutures for easy identification at time of delayed repair) and plan percutaneous nephrostomy
+*** '''If hemodynamically unstable: temporary urinary drainage followed by delayed definitive repair'''
-* Definitive repair of the injury should be performed when patient has improved/stabilized
+**** '''Options for temporary urinary drainage (4):'''
+****# '''Ureteral stent''' (internalized double J or exteriorized single J) '''only'''
+****# '''Short period of observation with a plan for reoperation when the patient is more stable, usually within 24 hours'''
+****# '''Exteriorize the ureter'''
+****# '''Tie off the ureter''' (with long silk sutures for easy identification at time of delayed repair) '''and plan percutaneous nephrostomy'''
+***** Definitive repair of the injury should be performed when patient has improved/stabilized
+*
 * Special scenarios Ureteral contusion Options, depending on ureteral viability and clinical scenario (2): Ureteral stenting
 * Resection with primary repair