Open Access

ARTICLE

Outcomes of renal salvage for penetrating renal trauma: a single institution experience

S. Johar Raza¹, Perry Xu¹, Justin Barnes², Robert Fisher¹, Allison May¹, Oussama Darwish¹, Brian Dang¹, Prajakta Adsul¹, Carl A. Freeman³, Sameer A. Siddiqui¹

1 Division of Urology, Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
2 Saint Louis University School of Medicine, St. Louis, Missouri, USA
3 Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
Address correspondence to Dr. Sameer A. Siddiqui, Division of Urology, St. Louis University Hospital, 3635 Vista Avenue, 3^rd Floor Deloge Tower, St. Louis, MO 63110 USA

Canadian Journal of Urology 2018, 25(3), 9323-9327.

Abstract

Introduction: Conservative management of penetrating renal trauma is emerging, with data originating from centers with variable levels of trauma care. This study reviews the outcomes of renal salvage after penetrating trauma at a level I trauma center.
Materials and methods: An institutional review board approved trauma registry at Saint Louis University Hospital was retrospectively analyzed for patients with penetrating renal trauma from 2009 to 2014. Patients were divided into nephrectomy group (NG) or non-nephrectomy group (non-NG), and compared. A multi-variable analysis was performed to determine predictors of nephrectomy, with cross-validation to evaluate the performance of the multi-variable model. Data was analyzed using R version 3.3.2. A p value of < 0.05 was considered significant.
Results: A total of 121 patients were identified with penetrating renal trauma. Gunshot injury was the leading cause of injury (87%). Eighteen (15%) patients required nephrectomy. The overall mean injury severity score (ISS) was 20. High-grade (grade 4-5) renal injuries were noted in 41 patients (34%). Among these, 14 patients (34%) underwent a nephrectomy, while 27 patients (66%) were managed conservatively to salvage renal units. CT grade of renal injury was the only predictor of nephrectomy on multi-variable analysis (OR 17.09, CI 2.75-105.99, p = 0.002). CT grade of injury and injury severity score were predictors of endoscopic intervention on a subgroup analysis of non-NG.
Conclusions: CT grade of injury predicts nephrectomy after penetrating renal trauma. Conservative management is a feasible option in penetrating renal trauma even with a higher grade of injury.

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