UROLOGICAL EVALUATION AND MANAGEMENT OF RENAL-PROXIMITY STAB WOUNDS

The urological evaluation and management of renal-proximity stab wound s remain controversial. Questions regarding the ''best'' first radiogr aphic study and the indications for nonoperative management are still unanswered. At the Los Angeles County-University of Southern Californi a Medical Center we retrospectively reviewed the charts of 244 patient s evaluated between January 1985 and December 1990 for renal-proximity stab wounds. There were 184 patients who presented without hematuria, 46 who presented with microscopic hematuria and 14 who presented with gross hematuria. When used as the first diagnostic study, an excretor y urogram was 96% accurate in establishing the presence or absence of injury. In 34 patients additional evaluation was done with computerize d tomography and/or angiography. A total of 43 injuries (17.6%) was fo und, of which 27 were successfully managed nonoperatively and 16 were managed surgically (1 nephrectomy). One patient had significant postop erative hemorrhage after partial nephrectomy, which was successfully m anaged with angiographic embolization. We conclude that although the d egree of hematuria was a good indication of renal injury, the absence of hematuria did not preclude injury. In addition, excretory urography appears to be an acceptably reliable first study at our institution. We advocate a renal angiogram as the second radiographic study of choi ce because it reliably stages significant injuries and offers the poss ibility of therapeutic transcatheter embolization. Most renal injuries , when accurately staged, can safely be managed nonoperatively.