The Literature Increasingly Supports Expectant (Conservative) Management of Renal Trauma — A Systematic Review

Santucci, Richard A.; Fisher, Mark B.

doi:10.1097/01.ta.0000179956.55078.c0

Cited by 180 publications

(129 citation statements)

References 90 publications

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“…Santucci et al, in a systematic review of renal trauma, demonstrated a significant variation in complication rate between the series revised, ranging from 0 to 34%, with a mean of 10%. 9 It can be explained by the fact that the majority of the studies are retrospective and comprises a small number of patients. Another important bias is the lack of standardization in some definitions.…”

Section: Discussionmentioning

confidence: 99%

Nonoperative Management of Blunt Renal Trauma

Azevedo¹,

Souza²,

Starling³

et al. 2015

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Objective: To analyze patients with blunt renal trauma who were managed conservatively, with emphasis on clinical presentation, grade of injury, complication and failure rates. Materials and methods:A prospective observational study was conducted in Hospital João XXIII, between January and December 2013. Patients with blunt renal trauma and nonoperative management (NOM) were analyzed during this period. Data were collected in respect to: age, gender, mechanism of trauma, grade of injury, clinical presentation, revised trauma score (RTS), associated abdominal injuries, length of hospital stay and failure, complication and mortality rates.Results: During this period, 27 patients with blunt renal trauma were suitable for nonoperative approach. The most common mechanisms of trauma were motor vehicle accidents (59.2%) and falls (22.2%) and the mean length of hospital stay was 10.5 days. The majority of the patients had grade II (48.1%) and III (29.6%) injuries, with mean RTS of 6.93. The complication rate was 3.7% and the mortality rate was 7.4%. All deaths were related to associated injuries. One patient with grade II injury required nephrectomy. This patient had concurrent injuries. Conclusion:Blunt renal trauma can be successfully managed conservatively, with low complication rates. Nonoperative management is safe in stable patients and in environments with appropriated protocol for this approach.

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Section: Discussionmentioning

confidence: 99%

Nonoperative Management of Blunt Renal Trauma

Azevedo¹,

Souza²,

Starling³

et al. 2015

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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“…The conservative management of blunt renal trauma was first proposed in the 1940s. [1] Since then the benefits of this approach have become increasingly apparent with reductions in nephrectomy rate, complications, and hospital stay all being reported. [1][2][3] There has been a paradigm shift towards conservative management for severe blunt trauma.…”

Section: Introductionmentioning

confidence: 99%

“…[1] Since then the benefits of this approach have become increasingly apparent with reductions in nephrectomy rate, complications, and hospital stay all being reported. [1][2][3] There has been a paradigm shift towards conservative management for severe blunt trauma. [1,[4][5][6][7][8][9] Successful management of renal injury depends upon accurate assessment of their extent.…”

Section: Introductionmentioning

confidence: 99%

“…The range of injuries for which conservative approach can be used has increased recently with the use of ureteric stents, percutaneous drainage and embolization. [1,4,5,8,10] There seems to be a wide variation in practice regarding issues such as repeat imaging, inpatient monitoring, thromboprophylaxis, antibiotics, discharge criteria, advice on return to regular activity and follow-up. Here we are presenting our experience in the management of renal trauma.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] There has been a paradigm shift towards conservative management for severe blunt trauma. [1,[4][5][6][7][8][9] Successful management of renal injury depends upon accurate assessment of their extent. With the advancement in radiologic imaging modalities and the ready availability of computed tomography allows surgeon to be much more informed about the injuries that they are treating.…”

Section: Introductionmentioning

confidence: 99%

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Management of Renal Trauma a Ret R Ospective Study - Our Experience

L¹,

Puvvada²,

Patil³

et al. 2015

jemds

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ABSTRACT:In the setting of blunt renal trauma and selected instances of penetrating renal trauma, a non-operative approach may be selected. Deep cortical lacerations with or without urinary extravasations followed by trauma have traditionally been managed by exploration and surgical repair. Patient selection is the preliminary step in adopting a non-operative management strategy to renal trauma. One series, with predominantly blunt mechanisms of injury, documented that 85% of patients were treated successfully without surgery. Ultimately, the exclusion of concurrent injury may be the key point in treating patients non operatively. With improved and easily available radiological imaging facilities like intravenous pyelography, ultrasonography, computed tomography and angiography, we propose that the majority of these injuries can be followed expectantly with delayed intervention if needed. 46 patients of abdominal trauma with significant renal injuries were reviewed. 16 patients had Grade I, 12 patients had grade II, 8 patients had Grade III, 6 had Grade IV renal injuries and 4 patients had Grade v. 37(80.4%) patients responded to conservative management. 9 patients required operative intervention. 25 patients had associated injuries. There was loss of 1 renal unit in 2 cases. With the aid of computed tomography, conservative therapy for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss.

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