[Blunt kidney injuries - operative or conservative therapy? A contribution to classification]

There is consensus concerning the management of minor (Grade I) and critical (Grade III) renal trauma, while the management of Grade II-lesions is contradictory. 48 consecutive cases of renal trauma were evaluated in order to define more exactly the indications of operative and non-operative therapy. As a diagnostic approach sonography and computerized tomography were added to urine examinations and intravenous pyelography, while angiography is only used when surgical intervention is expected. As therapeutic regimen for the intermediate group of Grade II b-lesions we recommend expectant management with "delayed urgency". This concept is based on a more differentiated classification particularly of major injuries (modified from Hodges and Lutzeyer). The importance of short-time clinical, sonographic and CT-control is underlined. Deterioration of clinical condition, associated injuries or pre-existent renal anomalies are indicating delayed operation. Emphasizing the intermediate group within major injuries between expectant conservative and operative management (about 5-10%) the main controversial issues are presented.