title: Nonoperative management of penetrating kidney injuries: a prospective audit.
abstract: OBJECTIVE
  The role of nonoperative management for penetrating kidney injuries is unknown. Therefore, we review the management and outcome of penetrating kidney injuries at a center with a high incidence of penetrating trauma.
  
  
  METHODS
  Data from all patients presenting with hematuria and/or kidney injury discovered on imaging or at surgery admitted to the trauma center at Groote Schuur Hospital in Cape Town, South Africa during a 19-month period (January 2007 to July 2008) were prospectively collected and reviewed. These data were analyzed for demographics, injury mechanism, perioperative management, nephrectomy rate and nonoperative success. Patients presenting with hematuria and with an acute abdomen underwent a single shot excretory urogram. Those presenting with hematuria without an indication for laparotomy underwent computerized tomography with contrast material.
  
  
  RESULTS
  A total of 92 patients presented with hematuria following penetrating abdominal trauma. There were 75 (80.4%) proven renal injuries. Of the patients 84 were men and the median age was 26 years (range 14 to 51). There were 50 stab wounds and 42 gunshot renal injuries. Imaging modalities included computerized tomography in 60 cases and single shot excretory urography in 18. There were 9 patients brought directly to the operating room without further imaging. A total of 47 patients with 49 proven renal injuries were treated nonoperatively. In this group 4 patients presented with delayed hematuria, of whom 1 had a normal angiogram and 3 underwent successful angioembolization of arteriovenous fistula (2) and false aneurysm (1). All nonoperatively managed renal injuries were successfully treated without surgery. There were 18 nephrectomies performed for uncontrollable bleeding (11), hilar injuries (2) and shattered kidney (3). Post-nephrectomy complications included 1 infected renal bed hematoma requiring percutaneous drainage. Of the injuries found at laparotomy 12 were not explored, 2 were drained and 5 were treated with renorrhaphy.
  
  
  CONCLUSIONS
  Penetrating trauma is associated with a high nephrectomy rate (24.3%). However, a high nonoperative success rate (100%) is achievable with minimal morbidity (9%).
authors.affiliation: Division of Urology and Trauma Center, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Moolman
authors.forename: P H
authors.initials: PH
authors.lastname: Navsaria
authors.forename: J
authors.initials: J
authors.lastname: Lazarus
authors.forename: A
authors.initials: A
authors.lastname: Pontin
authors.forename: A J
authors.initials: AJ
authors.lastname: Nicol
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D054869:Clinical Audit / Q000379:methods*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014567:Urography; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult