Management of major blunt renal lacerations: is a nonoperative approach indicated?
OBJECTIVE
The aim of the study was to determine whether a nonoperative approach is able to reduce renal parenchymal loss after renal trauma.


METHODS
Sixty-four consecutive patients with major blunt renal lacerations were treated from 1988 to 1999. Initial management was conservative. In group 1 (35 patients) delayed hemorrhage, persistent urinoma or hemodynamic instability were dealt with by open surgery. In group 2 (29 patients), most complications were dealt with using endoscopic procedures; open surgery was reserved exclusively for major complications.


RESULTS
In group 1, 7 patients were not operated and 28 patients were managed surgically. Twenty (57%) patients underwent total (8) or partial (12) nephrectomy. In 8 patients the surgical intervention was open drainage of perinephric collection (6) and/or renorrhaphies (2). Four patients in this group developed urinary fistulae treated successfully with ureteral stents. Length of hospital stay was 9.6 days (3-25 days). In group 2, persistent hemodynamic instability led to nephrectomy in 1 case. The remaining 28 patients were managed conservatively, with endoscopic ureteric stenting in 5 cases. A persistent urinary extravasation with hyperthermia led to open drainage of perinephric urinoma (5) and renorrhaphy (2). No delayed nephrectomy was necessary. Average hospital stay was 12 days (5-21 days). Only 1 patient in this group developed hypertension.


CONCLUSIONS
For most patients and with close follow-up available, conservative treatment represents a real alternative to open surgery in major blunt renal lacerations. In our experience, open surgery usually results in loss of renal parenchyma.
Moudouni
S M
SM
Department of Urology, CHU Pontchaillou, Rennes, France. s.moudouni@yahos.fr
Hadj Slimen
M
M
Manunta
A
A
Patard
J J
JJ
Guiraud
P H
PH
Guille
F
F
Bouchot
O
O
Lobel
B
B
D000293:Adolescent; D000328:Adult; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000628:therapy*