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[Closed traumatic ruptures of the normal upper urinary tract]
Journal D'Urologie
|January 1, 1983
Summary
Closed rupture of the upper urinary tract, though rare, often affects the pyelo-ureteric junction in children. Surgical repair is highly successful, preserving kidney function in most cases.
Area of Science:
- Urology
- Pediatric Surgery
- Trauma Surgery
Background:
- Closed rupture of the upper urinary tract is an uncommon but significant injury.
- This trauma most frequently involves the pyelo-ureteric junction, predominantly on the right side.
- Pediatric patients, particularly boys, are more susceptible to this condition.
Observation:
- Diagnosis is often delayed, typically identified by the formation of a urinary pseudocyst.
- Diagnostic imaging includes intravenous pyelography, ultrasound, and retrograde uretero-pyelography, performed just before surgical intervention.
- The pyelo-ureteric junction is the most common site for closed upper urinary tract rupture.
Findings:
- Surgical repair, often via uretero-ureteral, ureteropyelic, or ureterocalyceal anastomosis, is successful in the majority of cases.
- Autotransplantation is rarely indicated, reserved for complex cases with associated renal vascular pedicle injuries.
- Literature review of 64 cases shows 54 kidneys salvaged versus 10 nephrectomies, with only 3 nephrectomies resulting from failed repair attempts.
Implications:
- Advances in surgical techniques have dramatically improved outcomes for upper urinary tract rupture.
- Early diagnosis and prompt surgical repair are crucial for successful kidney preservation.
- This study highlights the high success rate of reconstructive surgery, contrasting with historical data.