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[Gunshot wounds of the kidneys]
Insights
Gunshot wounds to the kidneys often involve other organs, complicating treatment and diagnosis. Advanced imaging may improve kidney-sparing surgeries and patient outcomes.
Area of Science:
- Trauma Surgery
- Urology
- Emergency Medicine
Context:
- Analysis of 113 cases of renal gunshot wounds.
- High incidence (91.1%) of associated injuries to other viscera.
- Majority of patients (81.4%) presented in shock with hemorrhage.
Purpose:
- To evaluate the diagnosis and treatment of renal gunshot wounds.
- To identify factors influencing prognosis and outcomes.
- To explore the role of modern diagnostic methods.
Summary:
- Renal gunshot wounds frequently present with combined injuries, complicating diagnosis and treatment.
- Limited preoperative diagnostic capabilities (e.g., intravenous urography in 5.3%) led to frequent nephrectomies (62.8%).
- High mortality (50.4%) in severe combined injuries, with renal damage being a minor contributor to fatalities.
Impact:
- Urgent surgery was often necessary, limiting diagnostic workups.
- Hematuria was a key indicator of renal damage (74%).
- Implementing advanced imaging like CT, ultrasonography, and excretory urography could increase kidney-sparing procedures and improve survival rates.
Abstract:
Upon the analysis of the treatment for gunshot wounds of the kidneys (n = 113), it is concluded that in the majority of cases such wounds (91.1%) were associated with additional injuries of other viscera, this complicating the diagnosis and treatment, aggravating the prognosis. At admission, 81.4% of the wounded were in shock, with signs of hemorrhage. Serious condition of the patients dictated urgent surgery imposing limitations on diagnostic examinations, e.g. intravenous urography was performed in 5.3% of the cases only. Therefore, preoperative detection of renal injuries was far from universal. (55.6%). Hematuria prompted renal damage in 74% of cases. 92% of the wounded underwent surgery, in 62.8% of them it was nephrectomy. Serious combined wounds terminated in lethal outcomes in 50.4% of cases, though renal damage was responsible for 4% of deaths only. Introduction of up-to-date methods of examination (CT, ultrasonography, excretory urography) may raise the frequency of the kidney-preserving operations and favourable outcomes.