[Conservative approach in major renal trauma].
BACKGROUND
Genitourinary trauma amount to an 8-10% of abdominal trauma with the kidney being the most affected organ in 50% of cases, especially the left one. The choice of treatment will depend on the kind of lesion found in the affected renal unit and on the patient's clinical conditions.


OBJECTIVE
The aims of this study are twofold: to determine the applicability of conservative treatment in major renal trauma and to assess the evaluation and emergence of possible complications.


METHODS
We have analysed 309 cases of renal trauma dealt with in our department between January 1984 and January 2006, analyzing such variables as the etiology of the trauma, associated lesions in other organs, the therapeutic approach adopted as well as the presence of complications, both in the long and short run.


RESULTS
Out of a total of 309 renal trauma analyzed, a 94.1% (291 cases) were blunt renal trauma. The distribution by grade was: Grade I, 213 cases (69%); Grade II, 39 cases (12.6%); Grade III/IV, 32 cases (10.3%); Grade V, 25 cases (8%). We have given a conservative approach in the 84.6% of the grade III/IV cases (24 cases). 4 grade III nephrectomies were carried out in the Emergency Room because of haemodynamic instability, other 4 grade IV nephrectomies were done for the same reason, one of which was a partial nephrectomy, 48-72 hours after the trauma. The treatment for grade V was nephrectomy in 67%.


CONCLUSIONS
According to our experience and in the light of the results obtained, we consider the conservative approach adequate for major renal trauma as long as the patient is haemodynamically stable.
Delgado Oliva
F J
FJ
Servicio de Urología, Hospital La Fe, Valencia. frandelgol@hotmail.com
Bonillo García
M A
MA
Gómez Pérez
L
L
Oliver Amorós
F
F
Gimeno Argente
V
V
Jiménez Cruz
J F
JF
D006801:Humans; D007668:Kidney / Q000293:injuries*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000145:classification / Q000628:therapy