[Management of severe renal trauma].
OBJECTIVE
To analyse the progress in the management of severe renal trauma (Chatelain stage 3 and 4) over a period of 11 years.


METHODS
From December 1989 to June 2001, 21 patients were treated for severe renal trauma. Up until 1995, all patients were operated urgently or on the 7th day (n = 12). After 1995, patients were operated (n = 3) or managed nonoperatively (n = 6). We retrospectively studied the age, gender, type of trauma (open, closed), associated lesions, radiological assessment performed, treatment and complications.


RESULTS
20 males and 1 female with a mean age of 30.3 years were managed for severe renal trauma (17 stage 3 and 4 stage 4; 20 cases of closed trauma, 1 case of open trauma). The radiological assessment comprised ultrasound (13 cases), abdominopelvic CT (19 cases) and IVU (4 cases). Thirteen patients presented with multiple injuries with associated visceral (8 cases), bone (7 cases), or mixed (3 cases) lesions. Six patients were managed nonoperatively and 15 patients were operated: 6 urgently (4 total nephrectomies), 9 on the average of the 7th day (conservative treatment). Five patients developed long-term complications (4 cases of renal atrophy, 1 urohaematic pseudocyst). The median follow-up was 13.5 months.


CONCLUSIONS
The current approach to stage 3 renal trauma tends to be surveillance and nonsurgical management (carefully selected, haemodynamically stable patients). Vascular repair before the 5th hour is recommended for stage 4 trauma. Cases of delayed diagnosis of arterial thromboses are monitored.
Henry
Pierre-Charles
PC
Service de Chirurgie Urologique, Centre Hospitalo-Universitaire de Besançon, France.
Chabannes
Eric
E
Bernardini
Stéphane
S
Wallerand
Hervé
H
Bittard
Hugues
H
D000367:Age Factors; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000601:surgery / Q000628:therapy*