The management of renal injuries

Of 161 traumatic renal injuries analyzed for the period 1962-1975, 154 were due to blunt trauma and seven to penetrating wounds (5 gunshot wounds and 2 stab wounds). All the latter were treated by surgical exploration. Fifty-five patients had moderate injuries and 20 had severe injuries from nonpenetrating wounds and were managed without operation except for 10 cases that required surgical intervention. Of the patients with blunt trauma, 5% required nephrectomy, which is similar to the results reported with immediate operation. The other 79 patients (51%) with nonpenetrating injuries had only a renal contusion and were treated by bedrest and early ambulation. Conservative treatment is thus recommended for the more severe renal injuries; operative intervention is reserved for specific indications. The results of this approach are equal to those achieved by early surgical repair without subjecting a significant number of patients to an unnecessary operation.