Penetrating Renal Trauma: A Review of Modern Management

Background: To minimize acute kidney injury, trauma surgeons, urologists, and surgical intensivists alike have utilized conservative approaches when managing penetrating renal trauma. As this review of the literature demonstrates, even Grade IV penetrating renal injury with extravasation of contrast can be successfully managed with conservative therapy. Methods: A systematic review of currently published studies was performed following standard guidelines. The search was conducted through PubMed and included studies published in English that pertained to penetrating renal trauma. Studies were then limited to those published since 1980 that contained information regarding aetiology, diagnosis, and management of penetrating renal trauma were considered. Further selection and categorization was based on inclusion of information regarding outcomes and approach to management of penetrating renal trauma. Given the paucity of Level I and Level II evidence, all studies published over the last 50 years were initially screened for relevance. Results: Our initial data search yielded 350 potentially relevant studies; of these, approximately a dozen met the selection criteria based on inclusion of information regarding mortality, rates of complication, and approach to management. Limitations: Limitations of this article are like all review articles: the dependence on previously published research and availability of references as outlined in our methodology. There is also a lack of published Level I and Level II studies specific to this topic in the world’s literature. Conclusion: Management of penetrating renal trauma is complex and challenging. Literature published over the past five decades supports the fact that selective nonoperative management of penetrating renal injuries can and should be employed in the clinically stable patient.

Author(s): Phillips B, Mirzaie M and Turco L

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