SELECTIVE MANAGEMENT OF RENAL GUNSHOT WOUNDS

Background Gunshot wounds to the kidney have been managed traditionall y by surgical exploration. Concerns over increased nephrectomy rates a nd unnecessary explorations have placed this method under scrutiny. Se lective renal exploration based on solid clinical and radiographic cri teria may be a safer alternative and deserves evaluation. Methods The medical records of 52 consecutive patients with renal gunshot wounds, who were managed between September 1994 and August 1995 by a protocol of selective exploration, were reviewed. Renal injuries were explored only if they involved the hilum or were accompanied by signs of contin ued bleeding. Main outcome measures were the numbers of kidneys lost, as well as the morbidity and mortality related to the management of th e renal injury. Results Three patients died from associated injuries s hortly after admission. Fifteen patients suffered complications but on ly two had complications directly associated with the renal injury. Th irty-two patients underwent renal exploration and 17 of them required nephrectomy for major renovascular or parenchymal trauma (grade IV and V). Renal exploration was successfully avoided in the remaining 20 pa tients. No kidneys were lost unnecessarily as a result of this policy. Conclusion Mandatory exploration of all gunshot wounds to the kidney is not necessary. Injuries that produce stable peripheral haematomas d o not require exploration.