Traumatismes du rein et de l'uretère

Abstract

In France, renal lesions involve preferentially young men. They are often related to a multi organ trauma. Traumas of the upper urinary tract are likely to jeopardize the vital prognosis then nephrologic and urologic functional outcomes. Both the evaluation and the management of renal lesions were the subject of an international consensus in 2004. Clinical evaluation is based on trauma anamnesis, evaluation of the haemodynamic status of the patient, the presence of focal lumbar symptoms and hematuria. Except for the most benign traumas and life-threatening haemorrhages that necessitate immediate surgery, renal imaging may be indicated. Computed tomography is the best initial imaging technique that allows visualizing the anatomic lesion and evaluating the severity of the trauma. Renal pedicle and pyeloureteral junction avulsions are absolute indications for surgical exploration. For the other lesions, medical treatment or angiographic management can also be proposed. In any cases, conservative management should be preferred. The clinical and imaging follow up should focus on the vascular and secondary uro-nephrologic complications.