Applicability of blunt renal trauma classification of Japanese Association for the Surgery of Trauma (JAST).
OBJECTIVE
The Japanese Association for the Surgery of Trauma (JAST) classification is widely applied to select strategies in the treatment of blunt renal trauma in Japan. We retrospectively investigated the applicability of the JAST classification.


METHODS
The JAST classification comprises type I (subcapsular), type II (superficial), type III (deep) and pedicle vessel traumas. According to these criteria, we reviewed 70 patients with blunt renal trauma (types I, II, III and PV; n = 23, 22, 22 and 3, respectively) who were admitted to our institution between 1991 and 2007.


RESULTS
All patients with type I trauma were managed conservatively and three patients with PV trauma underwent nephrectomy. Whereas two patients with underlying acquired cystic disease of the kidney underwent nephrectomy among type II trauma, the other patients were treated conservatively. As four patients with type III trauma underwent nephrectomy, injury type subclass and hemorrhage severity were significant prognostic factors indicating the need for nephrectomy in this group. Since we introduced transcatheter arterial embolization in 1999, none of our patients have needed nephrectomy due to a hemorrhage, but one patient underwent nephrectomy because of persistent urine leakage.


CONCLUSIONS
Injury type and the hemorrhage severity are useful for determining treatment strategy. After the introduction of transcatheter arterial embolization, the proportion of nephrectomies due to exsanguination decreased and urine leakage also seems to be more important as a prognostic factor.
Department of Urology, Wakayama Medical University, Wakayama, Japan. n_zawajp@yahoo.co.jp
Satoshi
S
Nishizawa
Takashi
T
Mori
Yasuyo
Y
Shintani
Yasuo
Y
Kohjimoto
Takeshi
T
Inagaki
Isao
I
Hara
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan; D007668:Kidney / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000628:therapy*; D055815:Young Adult