Controvesial aspects of blunt renal trauma

Eighty-five cases of blunt renal trauma evaluated radiographically at our institution were reviewed. Thirty-eight patients had normal urograms; 47 demonstrated one or more of the following urographic findings: poor visualization, extravasation, intrarenal hematoma, perirenal hematoma, and kidney rupture. Nineteen arteriograms and twelve renal explorations were performed. Three explorations were negative; two were followed by repair of a laceration, three by nephrectomy, and four by heminephrectomy. A review of the factors of influencing the choice of surgical treatment and of the results obtained in patients who did not undergo surgery supports the recommendation of conservative management for stable patient. In the absence of clinical deterioration, neither the presence of extravasation nor the demonstration of renal fracture is an adequate indication for surgery. Angiography is useful to further document and classify renal injuries but is unnecessary for the conservative management of the stable patient. When surgery is contemplated, angiography is useful for surgical planning and for the exclusion of injury to adjacent structures, but it should not supplant clinical judgment in determining whether surgery is necessary.