A conservative approach to major blunt renal lacerations with urinary extravasation and devitalized renal segments

Objectives To determine the feasibility of a conservative (expectant) appro ach to major blunt renal laceration with urinary extravasation and devitali zed renal segments. Patients and methods All patients treated conservatively who presented betw een 1990 and 1999 with major renal laceration (grade 4 and 5) were retrospe ctively reviewed to determine whether urinary extravasation and devitalized segments adversely affected the outcome. For each patient the data collect ed included the initial emergency department evaluation, findings on comput ed tomography, associated injuries, duration of hospital stay, transfusion requirements, complications and follow-up imaging. Results Of 20 patients who sustained blunt trauma resulting in a major rena l laceration (five grade 5 and 15 grade 4) with urinary extravasation, 11 h ad coexisting devitalized segments. There was a statistically significant d ifference in the length of hospital stay (16.3 vs 7.3 days), blood transfus ions (six vs two patients, P<0.08) and the need for delayed surgical interv ention (nine vs two, P<0.01) between patients with and with no devitalized segments, respectively. Urinary extravasation spontaneously resolved in two of 11 patients with and in seven of nine with no devitalized segment, resp ectively (P<0.05) Conclusions Urinary extravasation will resolve spontaneously in most patien ts with blunt renal trauma, and expectant treatment does not adversely affe ct the outcome or prolong hospitalization. In patients who present with a m ajor renal laceration associated with devascularized segments, conservative management is feasible in those who are clinically stable with blunt traum a. However, the physician must be especially aware of the probable complica tions within this subset of patients.