Management of major blunt renal lacerations: Is a nonoperative approach indicated?

Objectives:The aim of the study was to determine whether a nonoperative app roach is able to reduce renal parenchymal loss after renal trauma. Methods: Sixty-four consecutive patients with major blunt renal lacerations were treated from 1988 to 1999. Initial management was conservative. In gr oup 1 (35 patients) delayed hemorrhage, persistent urinoma or hemodynamic i nstability were dealt with by open surgery. In group 2 (29 patients), most complications were dealt with using endoscopic procedures; open surgery was reserved exclusively for major complications. Results: In group 1, 7 patients were not operated and 28 patients were mana ged surgically. Twenty (57%) patients underwent total (8) or partial (12) n ephrectomy. In 8 patients the surgical intervention was open drainage of pe rinephric collection (6) and/or renorrhaphies (2). Four patients in this gr oup developed urinary fistulae treated successfully with ureteral stents. L ength of hospital stay was 9.6 days (3-25 days). In group 2, persistent hem odynamic instability led to nephrectomy in 1 case. The remaining 28 patient s were managed conservatively, with endoscopic ureteric stenting in 5 cases . A persistent urinary extravasation with hyperthermia led to open drainage of perinephric urinoma (5) and renorrhaphy (2). No delayed nephrectomy was necessary. Average hospital stay was 12 days (5-21 days). Only 1 patient i n this group developed hypertension. Conclusion: For most patients and with close follow-up available, conservat ive treatment represents a real alternative to open surgery in major blunt renal lacerations. In our experience, open surgery usually results in loss of renal parenchyma. Copyright (C) 2001 S. Karger AG, Basel.