Nonoperative management of blunt renal trauma: is routine early follow-up imaging necessary?
There is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma. We reviewed our experience with nonoperative management of blunt renal injuries in order to evaluate the utility of routine early follow-up imaging.
Methods: We reviewed all cases of blunt renal injury admitted for nonoperative management at our institution between 1/2002 and 1/2006.
Data were compiled from chart review, and clinical outcomes were correlated with CT imaging results.
Results: 207 patients were identified (210 renal units). American Association for the Surgery of Trauma (AAST) grades I, II, III, IV, and V were assigned to 35 (16%), 66 (31%), 81 (39%), 26 (13%), and 2 (1%) renal units, respectively.
177 (84%) renal units underwent routine follow-up imaging 24-48 hours after admission. In three cases of grade IV renal injury, a ureteral stent was placed after serial imaging demonstrated persistent extravasation.
In no other cases did follow-up imaging independently alter clinical management. There were no urologic complications among cases for which follow-up imaging was not obtained.
Conclusions: Routine follow-up imaging is unnecessary for blunt renal injuries of grades I-III.
Grade IV renovascular injuries can be followed clinically without routine early follow-up imaging, but urine extravasation necessitates serial imaging to guide management decisions. The volume of grade V renal injuries in this study is not sufficient to support or contest the need for routine follow-up imaging.
Author: John B Malcolm, Ithaar H Derweesh, Reza Mehrazin, Christopher J DiBlasio, David D Vance, Salil Joshi, Robert W Wake and Robert Gold
Credits/Source: BMC Urology 2008, 8:11
Published on: 2008-09-03
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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