No . 031. Renal trauma management in the new millennium. Rick L Catterwell , Mark Sparnon , Donna Clifford, Nicholas R Brook The Royal Adelaide Hospital, South Australia. Posters Proudly Supported by: . Results. Introduction
Renal trauma management in the new millennium
Rick L Catterwell, Mark Sparnon, Donna Clifford, Nicholas R Brook
The Royal Adelaide Hospital, South Australia
Posters Proudly Supported by:
Trauma is the highest cause of mortality in Australian males and females between 1 and 44 years of age1. Renal injury occurs in up to 5% of major trauma; the kidney is the most commonly injured genito-urinary organ. The majority of renal trauma has historically been managed conservatively2, 4.
Advances in imaging and treatment modalities, and an emphasis on nephron preservation, has expanded conservative management options in high grade renal trauma2. However, conservative management of high grade injuries may be associated with complications and late surgery5.
Mechanism of Renal Injuries (All and High Grade)
To examine the incidence, aetiologyand outcomes of contemporary management of renal trauma at South Australia’s major tertiary referral trauma hospital over a ten-year period.
Motor vehicle accidents (37%) and motor bike accidents (21%) were the most common cause of injury.
The majority of patients (74%) had multiple injuries; most commonly rib fractures (38%), liver (24%) or splenic (22%) lacerations. Isolated renal injuries were commonly sport related (48%) secondary to Australian Football (32%).
All patients admitted to The Royal Adelaide Hospital between 1st July 2002 and 30th June 2012 with traumatic renal injuries were identified using the hospital coding system.
Imaging was reviewed and assessed as per the American Association for the Surgery of Trauma (AAST) grading of renal injury3.
Angiography and successful lower pole embolization of a Grade IV renal injury
Complications occurred in ten patients (5.4%). One patient had a non-perfused kidney post embolization with persistent hypertension requiring delayed nephrectomy. One had a non-perfused kidney following nephron preserving surgery. Eight patients had a persistent urinoma (4.3%), of these 75% had not been appropriately imaged and 87% had not been stented. Three developed a peri-nephric abscess.
A delayed phase CT within 72 hours of injury is recommended in high grade injuries. This ensures adequate assessment of the collecting system5. In this cohort appropriate imaging was more likely to be performed in isolated injuries and those admitted under urological care.
There is controversy over stent or nephrostomy insertion to reduce risk of persistent urinoma1, 5. In this cohort persistent or infected urinoma was more common with incomplete staging or significant collecting system injuries not managed with early ureteric stent insertion.
Retrospective case and surgical note review was undertaken assessing for aetiology of injury, accompanying injuries, duration of stay, intervention required and complications.
Delayed contrast enhanced CT demonstrating a persistent urine leak in a Grade IV injury
Shoobridge JJ, Corcoran N M, et al. Contemporary Management of Renal Trauma. Rev Urol. 2011; 13(2): 65–72.
SantucciRA, Fisher MB. The literature increasingly supports expectant (conservative) management of renal trauma-a systematic review. J Trauma. 2005;59:493–503.
SantucciRA, McAninch JW, Safir M, et al. Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma. 2001;50:195–200.
Davis KA, Reed RL , 2nd, Santaniello J, et al. Predictors of the need for nephrectomy after renal trauma. J Trauma. 2006;60:164–169
AlsikafiNF, Rosenstein DI. Staging, evaluation, and nonoperative management of renal injuries. UrolClin North Am. 2006;33:13–19.