Role of Conservative Management in High Grade Renal Injuries: Our Experience at a Tertiary Care Centre

Abstract

Introduction:Renal injuries account for up to 1-5% of all trauma related injuries. Over the years there has been a shift towards non-operative treatment for blunt renal trauma. The aim of our study was to assess outcomes of patients managed conservatively (non-operatively) for high grade blunt renal injury at our centre. Material and methods:The study was conducted in a retrospective manner using hospital records of last 5 years. All patients with blunt renal injuries were included. These patients were categorized based on AAST(1989) injury grading and further subdivided into operative and non-operative management groups. These management strategies were analyzed in terms of 'failure of non-operative management', complications and need for adjunctive procedures. Descriptive analysis was done using Microsoft Excel(2010, ver14) software.Results: Forty three patients were included in the study with a mean age of 44.6 years. Out of the total, 28 had grade I -III injuries, 11 had grade IV and 4 had grade V injuries. All the grade I-III patients were managed conservatively and required no adjunctive procedures. One (9%) of grade IV and 2(50%) of grade V injuries underwent immediate exploration. Out of 10 cases of grade IV injuries which underwent nonoperative management, 3(30%) required delayed exploration and none of the grade V injuries required delayed exploration. Complications included urinary tract infection (UTI) (6 cases), persistent hematuria (3 cases), hypertension(2 cases), urinoma (2 cases) and ileus(2 cases) .All complications were Clavien grade 1-2 with no mortalities overall. Conclusion:If the patient is hemodynamically stable, even grade IV and V blunt renal injuries can be managed conservatively, as is seen in our study where failure of nonoperative management occured in only 30% of grade IV and none of the Grade V injuries.