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Verletzungen des Nierenbeckens und des Ureters

Diagnostik und Management

Injuries of the renal pelvis and ureter

Diagnosis and management

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Zusammenfassung

Etwa 5% aller Verletzungen des Harntrakts betreffen das Nierenbecken und den Ureter und stellen eine schwerwiegende Komplikation dar. Mit 75% ist der größere Teil dieser Verletzungen iatrogen bedingt, während nur etwa 25% auf Grund eines stumpfen Bauchtraumas oder einer offenen Verletzung entstehen. Zur Vermeidung von Komplikationen und Verbesserung der Prognose ist eine sofortige Diagnostik und Therapie entscheidend. Die Aussagefähigkeit der präoperativen Diagnosemöglichkeiten ist oft gering, sodass die Verletzung häufig erst bei einer explorativen Laparotomie entdeckt wird. Das Management von Läsionen des oberen Harntrakts ist abhängig von der Schwere und Lokalisation der Verletzung, wobei das oberste Ziel immer der Nierenerhalt sein muss. Grundsätzlich ist die Ureterstentung bei kleinen Verletzungen meist ausreichend und nur bei größeren Traumata eine offene Rekonstruktion indiziert. Hierbei konnte in Langzeitstudien eine hohe Rekonvaleszenz bei zeitnaher und adäquater Therapie dokumentiert werden.

Abstract

About 5% of injuries of the urinary tract affect the renal pelvis and ureter and constitute a severe complication. Around 75% of these injuries are iatrogenic and only about 25% are caused by blunt abdominal trauma or perforation. To avoid complications and improve prognosis, immediate diagnosis and therapy are essential. The diagnostic accuracy of preoperative studies is low, therefore frequently injuries are detected during explorative laparotomy. The management of upper urinary tract lesions depends on severity and localization, whereas the ultimate ambition should always be the preservation of the kidney. As a basic rule, ureteral stenting is mostly sufficient for small lesions, and only larger injuries require open reconstructive techniques. Longitudinal studies document a high degree of functional reconstitution if adequate and immediate treatment is carried out.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistraße 15, 81377, München, Deutschland

    M. Trottmann, S. Tritschler, F. Strittmatter, A. Becker, N. Haseke & C.G. Stief

  2. Institut für Klinische Radiologie der Ludwig-Maximilians-Universität München, München, Deutschland

    A. Graser

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  1. M. Trottmann
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  2. S. Tritschler
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  3. A. Graser
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  4. F. Strittmatter
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  5. A. Becker
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  6. N. Haseke
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  7. C.G. Stief
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Correspondence to M. Trottmann.

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Trottmann, M., Tritschler, S., Graser, A. et al. Verletzungen des Nierenbeckens und des Ureters. Urologe 46, 927–936 (2007). https://doi.org/10.1007/s00120-007-1373-y

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