Management of Renal Traumas and Follow-up Results: Single Center Experience
Abstract
Objectives: Kidney traumas constitute a small part of all abdominal traumas. There is debate about whether to choose a conservative or surgical approach. Nephrectomy is the most common surgical treatment for renal trauma. Conservative treatment may be considered for preservation of renal function. Fourth and fifth degree injuries are associated with poor functional outcomes.
Materials and Methods: Kidney trauma admitted to a third-degree reference center was evaluated. Renal trauma assessment was performed with the help of computed tomography. Age, gender, laterality, and hemoglobin levels were evaluated. cases that were followed conservatively and underwent surgery were recorded.
Results: The median age of the patients was 25 years (18-44 years). 71.4% (n=15) of the cases were conservatively managed. Surgical repair of the injured kidney was preferred for 1 of the cases (4.8%). Nephrectomy was performed for 2 cases (9.5%) and embolization was preferred 2 cases (9.5%). Surgical repair and removal of foreign body was performed for only 1 case with penetrating renal trauma (4.8%). All grade I and II traumas were treated conservatively. One of grade III traumas underwent surgical repair, 1 of them underwent surgical repair and removal of foreign body
and the other 4 patients were treated conservatively. One of grade IV traumas was performed nephrectomy, 1 of them underwent embolization and the other 4 were conservatively treated. For the patients with grade V traumas, 1 underwent nephrectomy and 1 was treated with embolization.
Conclusion: Different success rates have been reported for treatment approaches according to the literature. Both treatments have advantages and disadvantages. Conservative treatment is at the forefront in many patients, albeit at a high level. Interventions should be planned for hemodynamically unstable patients. This approach seems beneficial given its efficacy and safety. Thus, unnecessary kidney loss will be prevented.
Keywords
Renal Trauma, Nephrectomy, Conservative
Ethical Statement
Ethics Committee Approval: Ethical approval was obtained from University of Health Sciences Turkey, Gülhane Training and Research Hospital (2021-70).
Informed Consent: The study is a retrospective study. Peer-reviewed: Externally peer-reviewed.
References
- 1. Hampson LA, Radadia KD, Odisho AY, et al. conservative management of high-grade renal trauma does not lead to prolonged hospital stay. Urology. 2018;115:92-95
- 2. Roberts RA, Belitsky P, Lannon SG, et al. Conservative management of renal lacerations in blunt trauma. Can J Surg. 1987;30:253-255.
- 3. Lanchon C, Fiard G, Arnoux V, et al. High grade blunt renal trauma: predictors of surgery and long-term outcomes of conservative management. a prospective single center study. J Urol. 2016;195:106-111.
- 4. Stahlschmidt CM, Stahlschmidt FL, Von Bahten LC, et al. Conservative management of a grade V renal trauma associated with a grade III hepatic lesion: is it possible? Ulus Travma Acil Cerrahi Derg. 2006;12:311-314.
- 5. Pirinççi N, Kaba M, Geçit İ, et al. Conservative approach in the treatment of renal trauma in children. Urol Int. 2014;92:215-218.
- 6. Latabi AF, Aitzirri K, Moudouni SM, et al. Facteurs prédictifs d’échec du traitement conservateur du traumatisme rénal grade III–V [Factorspredicting of failure after conservative treatment in III-V grade renal trauma]. Prog Urol. 2019;29:416-422.
- 7. Keihani S, Anderson RE, Hotaling JM, et al. Diagnosis and management of urinary extravasation after high-grade renal trauma. Nat Rev Urol.2019;16:54-64.
- 8. Chebbi A, Peyronnet B, Giwerc A, et al. Observation vs. early drainage for grade IV blunt renal trauma: a multicenter study. World J Urol. 2021;39:963-969.
- 9. Keihani S, Putbrese BE, Rogers DM, et al. Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma. J Trauma Acute Care Surg. 2019;86:274-281.
- 10. Bayne DB, Tresh A, Baradaran N, et al. Does routine repeat imaging change management in high-grade renal trauma? Results from three level 1 trauma centers. World J Urol. 2019;37:1455-1459.