Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel

Abstract

Context: The most recent European Association of Urology (EAU) guidelines on urological trauma were published in 2014.

Objective: To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment.

Evidence acquisition: The EAU trauma guidelines panel reviewed literature by a Medline search on upper urinary tract injuries; publication dates up to December 2013 were accepted. The focus was on newer publications and reviews, although older key references could be included.

Evidence synthesis: A full version of the guidelines is available in print and online. Blunt trauma is the main cause of renal injuries. The preferred diagnostic modality of renal trauma is computed tomography (CT) scan. Conservative management is the best approach in stable patients. Angiography and selective embolisation are the first-line treatments. Surgical exploration is primarily for the control of haemorrhage (which may necessitate nephrectomy) and renal salvage. Urinary extravasation is managed with endourologic or percutaneous techniques. Complications may require additional imaging or interventions. Follow-up is focused on renal function and blood pressure. Penetrating trauma is the main cause of noniatrogenic ureteral injuries. The diagnosis is often made by CT scanning or at laparotomy, and the mainstay of treatment is open repair. The type of repair depends upon the severity and location of the injury.

Conclusions: Renal injuries are best managed conservatively or with minimally invasive techniques. Preservation of renal units is feasible in most cases. This review, performed by the EAU trauma guidelines panel, summarises the current management of upper urinary tract injuries.

Patient summary: Patients with trauma benefit from being accurately diagnosed and treated appropriately, according to the nature and severity of their injury.

Keywords: Blunt trauma; Conservative management; EAU; European Association of Urology; Guidelines; Kidney trauma/injury; Penetrating trauma; Surgical repair; Upper urinary tract trauma; Ureteral trauma/injury.