Comparison of Nonoperative Management With Renorrhaphy and Nephrectomy in Penetrating Renal Injuries

Bjurlin, Marc A.; Jeng, Eric I.; Goble, Sandra; Doherty, James; Merlotti, Gary J.

doi:10.1097/ta.0b013e318203321a

Cited by 27 publications

(40 citation statements)

References 18 publications

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Section: Results Results Results Resultsmentioning

confidence: 99%

“…Recognizing these lesions preoperatively and not manipulating them during surgery is the currently recommended conduct by the literature. This type of conduct is considered NOM by many authors 1,6,14,15 . In patients who have not had the chance to be submitted to imaging before surgery, it is recommended to check the presence, functionality and viability of the contralateral kidney before exploring the renal hematoma 8 .…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…Bjurlin et al 1 carried out a comparative analysis showing that NOM of penetrating renal injuries, including those by firearms, has lower mortality, lower incidence of transfusions and a shorter stay in intensive care compared with patients undergoing nephrectomy, but rates similar to those undergoing nephrorraphy.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…T he management of penetrating renal trauma has evolved, during the last decades, from the immediate surgical exploration to attempt to preserve kidney to the non-operative treatment (NOM) in selected patients 1 . The advance of imaging techniques and the development of an internationally validated classification of renal trauma 2 improved the severity staging of lesions and facilitated monitoring.…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

“…With current treatment options, most of haemodynamically stable patients with renal lesions can safely be subjected to such treatment 3 , provided that there is no associated injury imposing surgery. The authors who propose this approach can perform it in 10-40% of renal injuries from firearms, obtaining a success rate ranging from 91 to 100% 1,6,12,15,17 .In 1985, Heyns et al 4 conducted a randomized controlled trial of mandatory surgery versus NOM in patients with renal stabbing wounds, asymptomatic, diagnosed by pyelography. They realized that the NOM reduced the number of complications and decreased the length of hospital stay when compared with mandatory surgical treatment.…”

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confidence: 99%

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Tratamento não operatório das lesões renais por arma de fogo

Cesar

Starling

Drumond

2013

Rev. Col. Bras. Cir.

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(FAP) in the right thoraco-abdominal region in patients with hemodynamic stability and no signs of peritoneal irritation, highlighting the assessment of the safety of this approach. Methods Methods Methods Methods Methods: This was a prospective study with patients sustaining injuries by FAP in the right thoraco-abdominal region and kidney lesions, treated at the João XXIII Hospital (FHEMIG) in Belo Horizonte, from January 2005 to December 2012. Inclusion criteria were: hemodynamic stability, renal morphofunctional study by CT and no signs of peritoneal irritation. Results Results ResultsResults Results: A total of 128 patients met the inclusion criteria of the protocol and underwent NOM for right thoraco-abdominal injury by FAP. Of these, 37 (28.9%) had renal injuries. Trauma indexes: RTS 7.8, ISS16, and TRISS 99%. Lesions grade II and grade III were the most frequent. The most commonly associated intra-abdominal injury was of the liver, present in 81.1% of cases. Two patients (5.4%) had failed nonoperative treatment. Conclusion Conclusion Conclusion Conclusion Conclusion: The nonoperative treatment of such renal lesions, when properly indicated, has a high success rate, low complication rate and increases the chance of renal preservation. It is safe for well-selected patients in trauma centers with adequate infrastructure, experienced professionals and use of a specific protocol. T he management of penetrating renal trauma has evolved, during the last decades, from the immediate surgical exploration to attempt to preserve kidney to the non-operative treatment (NOM) in selected patients 1 . The advance of imaging techniques and the development of an internationally validated classification of renal trauma 2 improved the severity staging of lesions and facilitated monitoring. In addition, the appreciation of the hemodynamic stability of patients led to better NOM outcomes 3 .Despite the supposed benefits of nonoperative treatment, a minority of penetrating renal injuries can be treated without surgery by NOM and currently the option is still controversial. However, there is increasing evidence that even high degree renal injuries can be treated safely without intervention in the hemodynamically stable patient [4][5][6] .Although renal injuries by firearms are uncommon, they tend to produce complex lesions of the urinary system 6 . By contrast, there are few services that have sufficient number of patients with penetrating renal injuries, especially those by firearms, which allows the study of such cases.The aim of this study was to analyze the NOM of patients with renal lesions caused by firearm projectiles (FAP) admitted with hemodynamic stability and no signs of peritoneal irritation, with emphasis on the evaluation of the safety of this approach. METHODS METHODS METHODS METHODS METHODSWe conducted a prospective study in patients victims of assault by firearm in the right thoraco-abdominal region, with kidney injury, treated at João XXIII Hospital The protocol of HJXXIII for this type of approach includes i...

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