Conservative Management of Major Blunt Renal Trauma with Extravasation: A Viable Option?

Elashry, Osama M.; Dessouky, Basma Abdel Moneim

doi:10.1007/s00068-008-8105-x

Cited by 12 publications

(12 citation statements)

References 31 publications

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“…Those patients managed conservatively were found to have lower transfusion requirements, shorter hospital LOS, and fewer complications than those who were managed with surgical exploration. 8 These findings were also demonstrated by Altman et al in their study, in which 6 of 13 patients with grade 5 renal trauma were treated with conservative management. They found those patients treated conservatively had shorter LOS in the intensive care unit (ICU), lower transfusion rates, and fewer complications.…”

Section: Discussionsupporting

confidence: 69%

“…5,6 However, a paradigm shift has occurred in the past few decades, with growing evidence supporting the conservative management of renal injuries in hemodynamically stable patients. [7][8][9][10] Conservative management of most low-grade renal injuries has become the standard of care, and emerging evidence also supports conservative management in properly selected patients with high-grade renal injuries. 8,11 Protocols for conservative management of renal trauma vary among institutions and depend not only on the hemodynamic stability of the patient but also on the severity of injury.…”

Section: Resultsmentioning

confidence: 99%

“…[7][8][9][10] Conservative management of most low-grade renal injuries has become the standard of care, and emerging evidence also supports conservative management in properly selected patients with high-grade renal injuries. 8,11 Protocols for conservative management of renal trauma vary among institutions and depend not only on the hemodynamic stability of the patient but also on the severity of injury. Immediate nonoperative management of high-grade renal trauma includes bed rest, hydration, analgesia, and close monitoring including serial physical examinations and laboratory studies.…”

Section: Resultsmentioning

confidence: 99%

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et al. 2018

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Section: Discussionsupporting

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study

et al. 2018

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“…Approximately 90% of pediatric kidney injuries are due to blunt trauma. 7 Recently, there has been an increasing trend towards nonoperative treatments because the majority of these injuries can be successfully managed conservatively. 8,9 The severity of renal trauma is classified by an injury scale consisting of five grades, according to the American Association for the Surgery of Trauma (AAST).…”

Section: Discussionmentioning

confidence: 99%

Concurrent use of endourological and radiologic methods in the management of high-grade renal trauma

Akbari

Heran²,

Afshar

2016

CUAJ

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This case report explores the efficacy of simultaneous use of endourological and radiological methods to assess and manage high-grade renal trauma. A male rugby player was diagnosed with Grade 4 blunt renal trauma. A segment of the patient's kidney was isolated from the main renal pelvis with intact perfusion. This resulted in urinary extravasation. Ureteral stenting and angioembolization were used to treat the patient's severe symptoms. Angioembolization ablated functional tissue that was causing a persistent urinary leak. Following the treatment, the patient was discharged with no significant bleeding or leakage from the kidney. This report illustrates an uncommon use of this combined approach. Followup 18 months post-trauma revealed normal blood pressure and approximately 30% loss of volume of the affected kidney.

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“…[ 27 ] and Elashry et al . [ 28 ] managed 89% and 84.2% of their patients by conservative methods, respectively [ Table 2 ].…”

Section: Discussionmentioning

confidence: 99%

Salvageability of kidney in Grade IV renal trauma by minimally invasive treatment methods: A tertiary care single institute experience

Prakash

Mohan

Reddy

et al. 2015

J Emerg Trauma Shock

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Context:Renal trauma is increasingly being managed conservatively. Grade I-III injuries are managed conservatively whereas Grade V injuries may end in surgery. Managing Grade IV renal trauma is individualized and managed accordingly.Aims:To evaluate retrospectively all Grade IV renal injuries managed in our institute over five years and to review the available literature.Settings and Design:Reviewing the records of patients who sustained renal trauma and study all Grade IV renal injuries.Materials and Methods:We retrospectively analyzed all Grade IV renal injuries (16) managed at our institute between July 2008-August 2013. All patients were treated conservatively initially by hemodynamic stabilization, strict bed rest, if required endoscopic procedures. These patients were followed up with CECT.Statistical analysis:Descriptive statistics was performed using Microsoft excel spreadsheet 2007. Continuous data were described as mean and range. Categorical data was described as percentages.Results:Sixteen patients with Grade IV renal injury were included in the study. All patients had gross hematuria and 15 had urinary extravasation. D-J Stenting was done in 7 patients; perinephric tube drainage with D-J stentingwas done in 2 patients. One required selective upper pole arterial embolisation. Nephrectomy was not required in any of the patients. In the follow-up period, no patient had delayed complications.Conclusions:Successful conservative management of Grade IV renal trauma requires constant monitoring both clinically and radiologically, and if properly managed, kidneys can be salvaged in all stable patients as reinforced by our study.

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Conservative Management of Major Blunt Renal Trauma with Extravasation: A Viable Option?

Abstract: Our data supports the conservative management of grade IV blunt renal parenchymal injuries in the absence of hemodynamic instability of renal origin. Even select patients with grade V parenchymal injuries can undergo a trial of conservative management.

Cited by 12 publications

References 31 publications

Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study

Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study

Concurrent use of endourological and radiologic methods in the management of high-grade renal trauma

Salvageability of kidney in Grade IV renal trauma by minimally invasive treatment methods: A tertiary care single institute experience

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