CRITERIA FOR NONOPERATIVE TREATMENT OF SIGNIFICANT PENETRATING RENAL LACERATIONS

Purpose: We developed criteria for nonoperative treatment of penetrati ng renal injuries and predicting which patients will benefit from imme diate surgery. Materials and Methods: We reviewed the records of 120 p atients with grades 2 to 4 renal lacerations from gunshot and stab wou nds, of whom 41 were treated nonoperatively (group 1) and 79 underwent immediate renal exploration (group 2).Results: Group 1 had significan tly lower incidences of gunshot wounds, shock, associated injuries, ne ed for transfusion and high grade renal injuries. In patients with gra de 2 lacerations no complications resulted from nonoperative treatment . However, 23.5% of patients in group 1 with grades 3 and 4 injuries h ad delayed renal bleeding versus none in group 2. Conclusions: Nonoper ative treatment of penetrating renal lacerations is appropriate in hem odynamically stable patients without associated injuries. Grade 2 inju ries can be treated nonoperatively but grades 3 and 4 injuries are ass ociated with a significant risk of delayed bleeding if treated expecta ntly. Exploration should be considered if laparotomy is indicated for other injuries.