RENAL GUNSHOT WOUNDS - METHODS OF SALVAGE AND RECONSTRUCTION

Over the past 14 years, 2079 patients have been seen at our institutio n with renal trauma. Of these, 84 sustained gunshot wounds (81 unilate ral, 3 bilateral; a total of 87 renal units). We evaluated this group to characterize the nature of their injuries and establish a methodolo gy for renal salvage and reconstruction. Preoperative radiographic sta ging was performed with excretory urography (IVP) or computed tomograp hic (CT) scanning. The injuries were classified into five categories: 16 contusions (18.4%), 12 minor lacerations (13.8%), 44 major lacerati ons (50.5%), six vascular injuries (6.9%), and nine combination lacera tion and vascular injury (10.3%). Most patients had multiple organ inj uries, with 79 requiring associated surgical procedures (94%). The mea n Injury Severity Score (ISS) was 26.7 (range, 4-59). Based on radiogr aphic and clinical staging criteria, 69 renal injuries were surgically explored (79.3%), and 12 patients underwent nephrectomy (13.8%). Fort y-six renal units were reconstructed (66.6%) by various methods, inclu ding renorrhaphy, omental pedical flaps, mesh or peritoneal patch graf ts, partial nephrectomy, and vascular repair. Overall, 75 renal units were salvaged (86.2%). Early renal vascular control was achieved in al l patients who underwent renal exploration. Follow-up functional studi es were done in 24 (28.5%): none had delayed nephrectomy or postinjury hypertension. Overall, 79 patients survived (94%); however, mortality was not related to renal injury. These findings suggest that aggressi ve radiographic staging coupled with early vascular control and carefu l selection of reconstructive techniques can ensure a high renal salva ge rate in patients with renal gunshot injuries.