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Treatment

  • Initial management is conservative treatment, which consists of bed rest and analgesics.

  • Indications for immediate surgical intervention includes a renal pedicle injury, expanding pulsatile hematoma, or polytrauma in an unstable patient.

  • Persisting extravasation of urine normally resolves after the placement of a ureteral stent.

  • Urinomas usually resolve either with stent placement alone or with percutaneous drainage and stent placement.

  • If a perinephric abscess develops, a trial of antibiotics may be attempted if the abscess is less than 3 cm. If the abscess is greater 3 cm, then percutaneous drainage and antibiotics are usually required.

  • Catheter embolization may be used to treat pseudoaneurysms or aterio-venous fistulas that develop after the initial trauma.

Key Points
  • The kidney is the most commonly injured organ in the urinary tract.

  • Staging of the injury is dependent on depth of parenchymal involvement as well as involvement of collecting and vascular systems.

  • Treatment is dependent on staging and related complications.

References
  • Al-Qudah HS, Santucci RA. Complications of Renal Trauma. Urol Clin N Am 2006;33:41-53

  • Lee YJ, Oh SN, Rha SE, Byun JY. Renal Trauma. Radiol Clin N Am 2007;45:581-592

  • Santucci RA, Fisher MB. The Literature Increasingly Supports Expectant Management of Renal Trauma ¿ A Systematic Review. J Trauma 2005;59:491-501

  • Tinkoff G, et al. American Association for the Surgery of Trauma Organ Injury Scale I: Spleen, Liver, and Kidney, Validation Based on the National Trauma Data Bank. J. Am Coll Surg 2008;207:646-655
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