title: Successful Nonoperative Management of High-Grade Blunt Renal Injuries.
abstract: Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM (P= 0.01). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) (P= 0.01). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management.
authors.affiliation: Department of Surgery, Urology, Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA.
authors.forename: Allison M
authors.identifier: 0000-0002-6126-5964
authors.initials: AM
authors.lastname: May
authors.affiliation: Department of Surgery, Urology, Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA.
authors.forename: Oussama
authors.initials: O
authors.lastname: Darwish
authors.affiliation: Department of Surgery, Urology, Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Dang
authors.affiliation: Department of Surgery, Urology, Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Monda
authors.affiliation: Department of Surgery, Urology, Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA.
authors.forename: Prajakta
authors.initials: P
authors.lastname: Adsul
authors.affiliation: Department of Surgery, Urology, Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA.
authors.forename: Johar
authors.initials: J
authors.lastname: Syed
authors.affiliation: Department of Surgery, Urology, Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Siddiqui