Zusammenfassung
In bis zu 10% aller polytraumatisierten Patienten ist der Urogenitaltrakt und davon am häufigsten die Niere betroffen. Zur kritischen Überprüfung des eigenen Vorgehens wurden in einer retrospektiven Untersuchung über einen 10-Jahres-Zeitraum (9/1997–8/2007) Ätiologie, Art, Häufigkeit, diagnostisches Vorgehen, Therapie und Ergebnisse der im Unfallkrankenhaus Berlin behandelten polytraumatisierten Patienten mit Verletzungen der Nieren und ableitenden Harnwege ausgewertet (n=87). Neben der FAST(„focused assessment with sonography for trauma“)-Sonographie im Rahmen des Schockraummanagements wurden bei allen Patienten eine Computertomographie und bei Verdacht auf eine Harnröhren- oder Harnblasenverletzung zusätzlich eine retrograde Uretrographie mit Zystogramm durchgeführt. Die Verletzungen wurden in Abhängigkeit ihrer Schwere konservativ oder operativ versorgt. 5 Patienten mit urologischen Begleitverletzungen verstarben in den ersten 24 h. Die beim polytraumatisierten Patienten häufig zu beobachtenden urologischen Verletzungen erfordern sowohl in der Akutphase als auch im weiteren Verlauf eine gezielte Diagnostik und Therapie. Eine optimale Versorgung ist nur im Rahmen eines interdisziplinären Managements möglich.
Abstract
The urogenital tract and most often the kidneys are affected in up to 10% of multiple trauma patients. A critical appraisal of our own procedure was carried out in a retrospective study over a 10-year period (September 1997 to August 2007). The etiology, type, frequency, diagnostic procedure, treatment and results of multiple trauma patients in the emergency hospital in Berlin were evaluated (n=87, average age 33.8 years, range 6-73 years). In addition to using a focused assessment with sonography for trauma (FAST) procedure for trauma room management, all patients were examined by computed tomography and when ureter or bladder damage was suspected a retrograde uretography with cystogram was also carried out. The injuries were conservatively or surgically treated depending on the severity. Of the patients with additional urogenital injuries, 5 died within the first 24h. The urogenital injuries which often occur in multiple trauma patients require dedicated diagnostic and treatment not only in the acute phase but also in the course of the following phases. An optimal treatment can only be successful by means of interdisciplinary management.
Abbreviations
- AAST:
-
American Association for the Surgery of Trauma
- CT:
-
Computertomographie/Computertomogramm
- EAU:
-
European Association of Urology
- FAST:
-
„focused assessment with sonography for trauma“
- ISS:
-
„injury severity score“
- LKW:
-
Lastkraftwagen
- LWK:
-
Lendenwirbelkörper
- OIS:
-
„organ injury scale“
- PKW:
-
Personenkraftwagen
- ukb:
-
Unfallkrankenhaus Berlin-Marzahn
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Pretzer, J., Diederichs, W. Verletzungen der Nieren und ableitenden Harnwege beim Polytraumatisierten. Trauma Berufskrankh 10, 192–200 (2008). https://doi.org/10.1007/s10039-008-1432-7
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DOI: https://doi.org/10.1007/s10039-008-1432-7