Adult UrologyExperience with renal gunshot injuries in a rural setting
Section snippets
Material and methods
Between 1990 and 1994, 71 patients were hospitalized at our Departments of Urology and General Surgery with renal trauma. RGIs were noted in 42 patients (59.1%), and these patients made up the main group of this study. All patients underwent surgical exploration. The criteria establishing the presence of renal injury were the same as described previously by McAninch et al.2 A total of 45 kidneys (39 unilateral, 3 bilateral) were injured by gunshots during this period. Twenty-five patients
Results
The study group consisted of 37 males (88%) and 5 females (12%) between 15 and 68 years old (mean age 28 ± 2.4 and 27 ± 3.7 for male and female patients, respectively). Twenty-four of the patients (61.9%) had high-velocity bullet injury (HVBI), 12 patients had low-velocity bullet injury, and the other 6 patients had been wounded with shrapnel. Microscopic hematuria was present in 14 (33.3%) and macroscopic hematuria in 27 (64.2%). One patient with vascular injury had neither macroscopic nor
Comment
Our hospital serves people who live in 13 cities throughout the southeast and eastern regions of Turkey. Most trauma patients are transferred to this center for their final diagnosis and treatment. In rural areas, every residence has a gun for protection against enemies or for hunting. Additionally, the sociopolitical conditions of our region also increase the incidence of RGIs compared with other studies.1, 4, 7 Gunshot wounds may have a profound influence on surrounding tissues because of the
Conclusions
HVBI has a special nature. In rural areas, the type of weapon and condition of the patient during transfer to a trauma center can change the rate of, and reason for, nephrectomy. HVBI should be accepted as a subcategory of RGI.
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Cited by (29)
Renal Trauma Increases Risk of Future Hypertension
2018, UrologySurgical Management of Solid Organ Injuries
2017, Surgical Clinics of North AmericaCitation Excerpt :This is largely due to the particular vulnerability of the kidney to deceleration injuries following high-velocity impact trauma, as it is essentially tethered in place by just the vascular pedicle and renal pelvis.170,171 However, in more urban areas with higher rates of gun and knife violence, or regions with high levels of civil unrest, rates of penetrating renal trauma are much higher.163,172–174 Renal injuries occur along a spectrum, with most injuries being on the milder side of this range.164
Current epidemiology of genitourinary trauma
2013, Urologic Clinics of North AmericaExperience of open renal trauma in a urology service
2012, Actas Urologicas EspanolasMultidetector Computed Tomography of Penetrating Abdominal Trauma
2012, Seminars in RoentgenologyCitation Excerpt :CT findings suggestive of a diaphragmatic injury also include a wound track outlined by air, hemorrhage, or bullet fragments caused by the missile or knife extending to the diaphragm, focal thickening of the diaphragm, and a defect in the continuity of the normal diaphragm, even in the absence of associated hematoma or bleeding. Penetrating injuries to solid organs are almost always caused by gunshot or stab wounds, except for the few iatrogenic injuries resulting from percutaneous biopsy or other medical procedures.21-23 The mechanism consists of direct damage to the parenchyma itself, renal excretory system or biliary system, and vascular structures.
Evaluation and treatment of kidney penetrating wounds
2006, Annales d'Urologie