TY  - EJOU
AU  - Raza, S. Johar 
AU  - Xu, Perry 
AU  - Barnes, Justin 
AU  - Fisher, Robert 
AU  - May, Allison 
AU  - Darwish, Oussama 
AU  - Dang, Brian 
AU  - Adsul, Prajakta 
AU  - Freeman, Carl A. 
AU  - Siddiqui, Sameer A. 

TI  - Outcomes of renal salvage for penetrating renal trauma: a single institution experience
T2  - Canadian Journal of Urology

PY  - 2018
VL  - 25
IS  - 3
SN  - 1488-5581

AB  - <b>Introduction:</b> 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.<br/>
<b>Materials and methods:</b> 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.<br/>
<b>Results:</b> 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.<br/>
<b>Conclusions:</b> 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.
KW  - penetrating trauma
KW  -  renal
KW  -  nephrectomy
KW  -  outcomes

DO  -