Evaluation of urinary extravasation after non-operative management of traumatic renal injury: a multi-center retrospective study

Abstract

Purpose Urinary extravasation is one of the major complications after non-operative management of traumatic renal injury and may lead to urinary tract infection and sepsis. The purpose of this study was to evaluate these factors in patients with traumatic renal injury. Methods This was a multi-center, retrospective, observational study performed at three tertiary referral hospitals in Osaka prefecture. We included patients with traumatic renal injury transported to the centers between January 2008 and December 2018. We excluded patients who either died or underwent nephrectomy within 24 h after admission. We investigated the occurrence of urinary extravasation and the related factors after traumatic renal injury using multivariable logistic regression analysis. Results In total, 146 patients were eligible for analysis. Their median age was 44 years and 68.5% were male. Their median Injury Severity Score was 17. Renal injuries were graded as American Association for Surgery of Trauma (AAST) grade I in 33 (22.6%), II in 27 (18.5%), III in 38 (26.0%), IV in 28 (19.2%), and V in 20 (13.7%) patients. Urinary extravasation was diagnosed in 26 patients (17.8%) and was statistically significantly associated with AAST grades IV–V (adjusted odds ratio, 33.8 [95% confidence interval 7.12–160], p < 0.001). Conclusion We observed urinary extravasation in 17.8% of patients with non-operative management of traumatic renal injury and the diagnosed was made in mostly within 7 days after admission. In this study, the patients with AAST grade IV–V injury were associated with having urinary extravasation.

Right-Sided Urinary Extravasation Caused by a Ureteral Stone and Associated With Peritonitis in an Older Woman

“…The relationship between urinary tract tissues regarding internal pressure can explain the pathophysiology of urinary extravasation. In our case, when renal pelvic pressure rises due to stone impaction, it causes microscopic fissures in the anatomically weakest part of the renal calyx [8,9]. As a result, urine overflows outside the renal pelvis.…”

“…Thus, pressures >30-45 mmHg cause extrarenal overflow [10]. Although extrarenal overflow may occur at 20 mmHg, it may not occur at 100 mmHg [8,9]. This indicates that the speed of increase in renal pelvic pressure is more important than absolute renal pelvic pressure.…”

“…The average age at which urinary extravasation occurs is 53 years, with men and the left side more likely to be affected than women and the right side [8,9]. Ureteral stones are the most common cause, followed by urogenital and extra-urinary tumors [10].…”

Arteriovenous Fistula: The Case of a Rare Complication after Minimal Percutaneous Nephrostomy and Brief Review

“…The complications of this method are those associated with any minimally invasive surgical procedure: vascular injury, damage to nearby organs, and infection [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. The Society of Cardiovascular and Interventional Radiology and the American College of Radiology have shown that percutaneous nephrostomy is associated with less than 4% major bleeding or septic shock [ 17 ].…”