Surgical management of renal trauma: analysis of risk factors, technique, and outcome

The impact of the extent of renal injury and the method of treatment on patient outcome has not been well defined. Ninety-two patients with 96 renal injuries treated by a variety of surgical methods were evaluated to determine whether outcome was influenced by the extent of renal injury (minor, major, vascular, or bilateral) or the method of treatment (exploration alone, renorrhaphy, partial nephrectomy, nephrectomy, vascular repair, combined surgery, or bilateral surgery). Each patient was assessed for the extent of associated injury (injury score, transfusion requirement), the presence of shock, degree of hematuria, type of injury and method of repair, incidence of major complications, and azotemia (creatinine greater than 1.5 mg/dl). Eight patients died, ten developed azotemia, and 35 developed a major complication. There was a statistically significant association between the extent of injury and the development of azotemia. A statistically significant relationship was noted between the type of repair (nephrectomy, combined and bilateral surgery) and the development of azotemia, major complication and eventual death. These relationships, however, seemed to be a product of the extent of associated injury and consequent development of sepsis and multiple organ failure rather than the extent of renal injury or the method of repair.