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.
- 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.
- 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
We welcome your feedback, please send questions and comments to Marcel Maya, MD