Management of major blunt renal lacerations: surgical or nonoperative approach?
OBJECTIVE
To evaluate changes in the management of major blunt renal trauma since the introduction of computerized tomographic diagnosis and follow-up.


METHODS
Twenty-three consecutive patients with deep blunt renal lacerations without major pedicle injury or shattered kidney were treated from 1986 to 1995. In group 1 (1986-1989, 12 patients), initial management was conservative, but with open surgery in cases of hemodynamic instability or persistent urinary extravasation. In group 2 (1990-1995, 11 patients), a plain conservative approach was followed and open surgery was reserved for major complications only.


RESULTS
In group 1, 6 patients required early renal exploration (4 nephrectomies, 2 renorrhaphies). A persistent urinary fistula led to late nephrectomy in 1 of the renorrhaphy patients. Retroperitoneal hematoma and urinary extravasation spontaneously resolved in 6 cases. Length of hospital stay was significantly lower (p = 0.02) for nonoperated patients. None suffered from hypertension at long-term follow-up (5-8 years, mean 7.2). In groups 2, all 11 patients were treated conservatively, with endoscopic ureteric stenting in 4 cases. Urinary extravasation always resolved, but 9 patients had residual perirenal hematoma at the time of discharge. Length of hospital stay was significantly higher (p = 0.0005) with ureteric stenting. Nine months after trauma, 1 patient suffered from recurrent pyelonephritis. Radiographic follow-up (1-30 months, mean 10.2) revealed minor sequelae in all evaluated patients.


CONCLUSIONS
In most patients with major blunt renal lacerations, a conservative approach is safe. Most extravasation spontaneously resolves and minimally invasive techniques will deal with nearly all complications. In our experience, open surgery usually results in nephrectomy.
Robert
M
M
Urology Department, Lapeyronie University Hospital, Montpellier, France.
Drianno
N
N
Muir
G
G
Delbos
O
O
Guiter
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000293:injuries*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications; D011704:Pyelonephritis / Q000209:etiology; D014548:Urinary Fistula / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy*