Criteria for nonoperative treatment of significant penetrating renal lacerations.
OBJECTIVE
We developed criteria for nonoperative treatment of penetrating renal injuries and predicting which patients will benefit from immediate surgery.


METHODS
We reviewed the records of 120 patients with grades 2 to 4 renal lacerations from gunshot and stab wounds, of whom 41 were treated nonoperatively (group 1) and 79 underwent immediate renal exploration (group 2).


RESULTS
Group 1 had significantly lower incidences of gunshot wounds, shock, associated injuries, need for transfusion and high grade renal injuries. In patients with grade 2 lacerations no complications resulted from nonoperative treatment. However, 23.5% of patients in group 1 with grades 3 and 4 injuries had delayed renal bleeding versus none in group 2.


CONCLUSIONS
Nonoperative treatment of penetrating renal lacerations is appropriate in hemodynamically stable patients without associated injuries. Grade 2 injuries can be treated nonoperatively but grades 3 and 4 injuries are associated with a significant risk of delayed bleeding if treated expectantly. Exploration should be considered if laparotomy is indicated for other injuries.
Wessells
H
H
Department of Urology, University of California School of Medicine, San Francisco, USA.
McAninch
J W
JW
Meyer
A
A
Bruce
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008875:Middle Aged; D014950:Wounds, Penetrating / Q000150:complications / Q000628:therapy*