Major renal trauma: retrospective study of 18 cases

The authors report a retrospective study concerning 18 patients having majo r renal trauma. The patients study group was comprised of 11 males (61%) an d seven females (39%) with a mean age of 23 years. The etiologic agents wer e traffic accident (eight cases), falls (five cases) and stab wounds (five cases). Gross hematuria was present in all the patients. After radiologic i nvestigations the renal injuries were classified according to the American Association for Surgery of Trauma. Two patients were in stage V, seven in s tage IV and nine in stage III. Three patients were operated in emergency fo r hemodynamic instability, two had a total nephrectomy and one a partial ne phrectomy. Five patients underwent surgery between the 5th and 7th day, thr ee had a suture of the renal parenchyma under a nephrostomy, one a partial nephrectomy and the third a total nephrectomy. Two patients had only a urin ary drainage by placement of an ureteral stent in order to diminish the uro hematoma. Eight patients were treated conservatively and all were in stage III. The mean rretreat was 16 months. There was no mortality and among the eight patients who underwent surgery, none had complications, aside from tw o wound infections. The patients who were managed conservatively had good p rogression; they all had a control by computed tomography which showed that the urohematoma had decreased. None of the patients developed hypertension or infection of the urohematoma. (C) 2000 Editions scientifiques et medica tes Elsevier SAS.