Renal gunshot wounds: methods of salvage and reconstruction.
Over the past 14 years, 2079 patients have been seen at our institution with renal trauma. Of these, 84 sustained gunshot wounds (81 unilateral, 3 bilateral; a total of 87 renal units). We evaluated this group to characterize the nature of their injuries and establish a methodology for renal salvage and reconstruction. Preoperative radiographic staging was performed with excretory urography (IVP) or computed tomographic (CT) scanning. The injuries were classified into five categories: 16 contusions (18.4%), 12 minor lacerations (13.8%), 44 major lacerations (50.5%), six vascular injuries (6.9%), and nine combination laceration and vascular injury (10.3%). Most patients had multiple organ injuries, with 79 requiring associated surgical procedures (94%). The mean injury Severity Score (ISS) was 26.7 (range, 4-59). Based on radiographic and clinical staging criteria, 69 renal injuries were surgically explored (79.3%), and 12 patients underwent nephrectomy (13.8%). Forty-six renal units were reconstructed (66.6%) by various methods, including renorrhaphy, omental pedical flaps, mesh or peritoneal patch grafts, partial nephrectomy, and vascular repair. Overall, 75 renal units were salvaged (86.2%). Early renal vascular control was achieved in all patients who underwent renal exploration. Follow-up functional studies were done in 24 (28.5%): none had delayed nephrectomy or postinjury hypertension. Overall, 79 patients survived (94%); however, mortality was not related to renal injury. These findings suggest that aggressive radiographic staging coupled with early vascular control and careful selection of reconstructive techniques can ensure a high renal salvage rate in patients with renal gunshot injuries.
McAninch
J W
JW
Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
Carroll
P R
PR
Armenakas
N A
NA
Lee
P
P
D000328:Adult; D001803:Blood Transfusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D008297:Male; D009392:Nephrectomy / Q000379:methods; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013518:Surgery, Plastic / Q000379:methods*; D013524:Surgical Flaps / Q000379:methods; D015996:Survival Rate; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D014567:Urography; D014948:Wounds, Gunshot / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*