Radiographic assessment of blunt renal trauma

Recent reports in the urologic literature suggest that radiographic evaluation of normotensive blunt trauma patients with microscopic hematuria is no longer necessary. Several facilities, however, including the Los Angeles County-University of Southern California Medical Center continue to routinely perform intravenous pyelography in this setting. To further evaluate whether this practice is indicated, we retrospectively reviewed the records of 337 patients seen at our facility between May, 1986 and December, 1989 following blunt trauma with resultant microscopic hematuria but no shock. All patients were radiographically assessed with an intravenous pyelogram. Of the 337 studies, 30 (9%) had an abnormal result, including 28 renal contusions, 1 ureteropelvic junction (UPJ) disruption, and 1 non-functioning kidney (which on further evaluation revealed a congenitally absent kidney). A total of 1 significant urologic injury was identified. Thus, only one injury (0.3%) would have been missed if a policy of observation was followed in this group of patients. Our data support other reports in the urologic literature that radiographic staging is not necessary in managing blunt trauma patients with microscopic hematuria but no shock.