Abstract
PurposeUrinary extravasation is one of the major complications after non-operative management of traumatic renal injury and may lead to urinary tract infection and sepsis. The purpose of this study was to evaluate these factors in patients with traumatic renal injury.MethodsThis was a multi-center, retrospective, observational study performed at three tertiary referral hospitals in Osaka prefecture. We included patients with traumatic renal injury transported to the centers between January 2008 and December 2018. We excluded patients who either died or underwent nephrectomy within 24 h after admission. We investigated the occurrence of urinary extravasation and the related factors after traumatic renal injury using multivariable logistic regression analysis.ResultsIn total, 146 patients were eligible for analysis. Their median age was 44 years and 68.5% were male. Their median Injury Severity Score was 17. Renal injuries were graded as American Association for Surgery of Trauma (AAST) grade I in 33 (22.6%), II in 27 (18.5%), III in 38 (26.0%), IV in 28 (19.2%), and V in 20 (13.7%) patients. Urinary extravasation was diagnosed in 26 patients (17.8%) and was statistically significantly associated with AAST grades IV–V (adjusted odds ratio, 33.8 [95% confidence interval 7.12–160], p < 0.001).ConclusionWe observed urinary extravasation in 17.8% of patients with non-operative management of traumatic renal injury and the diagnosed was made in mostly within 7 days after admission. In this study, the patients with AAST grade IV–V injury were associated with having urinary extravasation.
Highlights
The occurrence of traumatic renal injury has been reported to range between 0.3 and 1.2% of all traumatic injuries, and the most common mechanism is blunt trauma [1, 2]
IQR interquartile range, ISS Injury Severity Score, Association for Surgery of Trauma (AAST) American Association for the Surgery of Trauma, TAE transcatheter arterial embolization, CT computed tomography observed a trend towards an increased risk of having urinary extravasation in those with gross hematuria (Table3)
We found that patients with AAST grade IV–V renal injury were highly associated with urinary extravasation
Summary
The occurrence of traumatic renal injury has been reported to range between 0.3 and 1.2% of all traumatic injuries, and the most common mechanism is blunt trauma [1, 2]. Traumatic blunt renal injury is treated with operative or complications associated with non-operative management can occur and require appropriate intervention. A previous multicenter cohort study reported the occurrence of complications to be 32.4% among blunt renal trauma patients [4]. Urinary extravasation is one of the major complications of renal trauma. A previous systematic review reported that the occurrence of the urinary extravasation was 29% among patients with high-grade renal injury [5], and abscess and sepsis may develop if the diagnosis and treatment are delayed [6].
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