Changing paradigms of management of isolated blunt renal trauma

Abstract

Introduction The last thirty years has seen a change in management of renal trauma with progression more towards nonoperative management; however there is lack of guidelines of many practical aspects for conservative management of renal trauma. Here we are sharing our experience of managing isolated renal trauma over a period of five years. Materials and methods The study was conducted in a tertiary care centre of eastern part of India from April 2015–March 2020. It was a retro-prospective study and included cases of isolated blunt renal trauma managed in our hospital. Results A total of 61 cases of isolated blunt renal trauma were treated in the mentioned time period. Seventeen (28%) cases were of AAST Grade IV and five (8%) Grade V injury. Blood transfusion was required in eighteen (29%) cases during management. In eight (47%) cases of Grade IV injury and two (40%) cases of Grade V injury angioembolization was done. In two (11.7%) cases of Grade IV injury ureteral stenting was performed. Delayed surgical exploration and nephrectomy was required in one case of Grade V injury because of failed angioembolization and one Grade IV injury due to sepsis. One death was encountered in Grade V injury who had delayed presentation with haemorrhagic shock and underwent immediate surgical exploration. On follow up four patients (23%) of Grade IV injury and one patient of Grade III injury and two patients (40%) of Grade IV injury developed hypertension. The remaining patients were found to be normal. Conclusion Conservative management of renal trauma is the norm nowadays. Angioembolisation was found to be one of the strongest armamentarium when patient needs intervention. Surgery is rarely contemplated, mostly in hemodynamically unstable high grade trauma patients.