Abstract text (incl. references and figure legends)
Introduction
Urological trauma has been reported with a frequency up to 12% in trauma patients. Combined with abdominal trauma, penetrating or blunt, the numbers may rise up to 50%. Diagnosis and treatment strategies can be quite challenging for a trauma surgeon particularly with a patient in extremis. In military operations the limited material resources and the tactical situation are relevant for the surgeon´s strategy in addition to the physical status of the patient. Related rules apply for smaller hospitals with no urological surgeon on call or present at all.
Material and methods
Based on two case reports of trauma patients we demonstrate potential urological injuries, diagnostics and treatment.
Case report
The first patient suffered from an abdominal stab wound with a laceration of the stomache and the hilus vessels of the left kidney. The initial attempt to preserve the kidney and perform vascular sutures wasn´t successful, so the kidney had to be removed in an early second look laparotomy.
The second patient was a victim of a traffic accident with an extensive belt injury of the right abdomen. As a part of the initial damage control procedures a right nephrectomy hab to be performed.
Discussion
Urological injuries are not as rare as assumed, often they can be treated conservatively until transfer to a specialized treatment facility is possible. However a trauma surgeon may face patients in extremis particularly with abdominal trauma, who require urgent urological surgery. Therefor a broad training for damge control surgery strategies in urological trauma must be mandatory to gain the necessary skills. In adverse situations a nephrectomy or nephrostomy might be lifesaving procedures. The learning of how to deal with traumatized patients is an ongoing and challanging process for every trauma surgeon, especially in a world of progressive specialization and minimal-invasive surgery. It needs training on a regular base and sharing of practical knowledge.
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