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Advances in Urology
Volume 2016 (2016), Article ID 3568076, 5 pages
http://dx.doi.org/10.1155/2016/3568076
Research Article

Successful Nonoperative Management of High-Grade Blunt Renal Injuries

Department of Surgery, Urology, Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA

Received 31 August 2016; Revised 19 October 2016; Accepted 24 October 2016

Academic Editor: Kostis Gyftopoulos

Copyright © 2016 Allison M. May et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM (). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) (). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management.