CONSERVATIVE MANAGEMENT OF MAJOR BLUNT RE NAL TRAUMA

The choice of treatment (surgical or conservative) for major renal tra uma still remains controversial. The objective of this study was to co mpare the results of patients with major renal trauma (grade III and I V) primarily treated by surgical intervention (1980-1992) with those i n patients mainly treated conservatively (1992-1995). Between 1980 and 1995, 83 patients with major renal trauma were hospitalized at our in stitution. Our results show a higher nephrectomy rate of 44% in the ca se of primary surgical intervention compared to conservative managemen t (27%). The outcome of twenty-two patients treated conservatively was analyzed prospectively with repeated radiological imaging, blood pres sure profiles, and renal function assessment by means of MAG 3 renal s cintigraphy. No patient developed renovascular hypertension and the re lative function of the traumatized kidney was greater than 40% in 95% of patients. In conclusion, our results confirm a lower nephrectomy ra te in the case of conservative management without any increase of the immediate or long-term morbidity. Major renal trauma (grade III, IV) c an therefore be effectively treated by conservative management and pri mary surgical repair is only indicated in patients with hemodynamic in stability, persistent hematuria and associated visceral injuries.