Which renal lacerations will heal satisfactorily with nonsurgical management?

If there was a correlation between the type of renal laceration and its healing, and if radiologic evaluation on admission could accurately diagnose the type of renal laceration present, then surgical intervention could be reserved for those renal lacerations that will not heal satisfactorily by themselves. We reviewed the outcome of initially conservative or immediate operative treatment of renal laceration in 122 patients. Thirty-six patients were managed initially without operation. All fifteen cortical lacerations and all five deep lacerations that created only a small parenchymal defect healed themselves, with 4 of the 16 patients available for follow-up having hypertension. In contrast, six deep lacerations that caused large parenchymal defects, six disrupted poles or segments, and four split kidneys did not have satisfactory healing with conservative management, necessitating delayed renal surgery, or causing hypertension or both. Because computed tomography on admission can accurately diagnose the site and extent of a renal laceration, it should be possible to decide early which patients truly will benefit from conservative management.