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

Renal Travmaya Yaklaşım ve Takip Sonuçları: Tek Merkez Deneyimi

Abstract

Amaç: Böbrek travmaları tüm karın travmalarının küçük bir kısmını oluşturur. Konservatif mi yoksa cerrahi yaklaşım mı tercih edileceği konusunda tartışmalar vardır. Nefrektomi, renal travmanın en yaygın cerrahi tedavisidir. Konservatif tedavi böbrek fonksiyonunun korunması için düşünülebilir. Dört ve beşinci derece yaralanmalar kötü fonksiyonel sonuçlarla birlikte beraberliği mevcuttur. Gereç ve Yöntem: Üçüncü derece referans merkezine kabul edilen böbrek travmaları değerlendirildi. Renal travma değerlendirmesi bilgisayarlı tomografi yardımı ile yapıldı. Yaş, cinsiyet, lateralite, hemoglobin seviyeleri değerlendirildi. Konservatif takip edilen ve cerrahi uygulanan olgular kaydedildi. Bulgular: Hastaların medyan yaşı 25 (18-44 yıl) olarak saptandı. Olguların %71,4’ü (n=15) konservatif olarak takip edildi. Yaralanan böbreğin cerrahi onarımı olguların 1’inde (%4,8) tercih edildi. İki olguya (%9,5) nefrektomi yapıldı ve 2 olguya (%9,5) embolizasyon tercih edildi. Penetran renal travmalı sadece 1 olguda (%4,8) cerrahi onarım ve yabancı cisim çıkarıldı. Sonuç: Literatüre göre tedavi yaklaşımları için farklı başarı oranları bildirilmiştir. Her iki tedavinin de avantajları ve dezavantajları vardır. Konservatif tedavi, yüksek dereceli de olsa birçok hastada ön plandadır. Hemodinamik açıdan stabil olmayan hastalar için müdahaleler planlanmalıdır. Bu yaklaşım, etkinliği ve güvenliği göz önüne alındığında faydalı görünmektedir. Böylelikle gereksiz böbrek kaybı önlenmiş olacaktır.

Keywords

• Renal Travma
• Nefrektomi
• İzlem

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