The Characteristics of Renal Trauma Patients Who Needed Surgical Management

Kim, Jin Hong; Kim, Young Gon; Park, Jong Kwan; Park, Young Kyung

Abstract

We reviewed 113 patients of renal trauma between May, 1989 and May, 1995 to clarify the characteristics of the patients who need surgical management. Of the 113 renal trauma patients, 80 were treated conservatively and remaining 33 were treated with surgically. The causes of injury were blunt trauma in 112 and penetrating injury with gunshot in 1. The grade of injury was contusion in 48 (42.5%), simple laceration in 25 (22.1 %), deep laceration into collecting system in 26 (23.0%), shattered kidney in 7 (6.2%), and pedicle injuries in 7 (6.2%). Aside from 1 case of grade 2 Wilms' tumor patient, all the surgically treated patients were over grade 3. Surgically treated patients had more associated trauma, especially in nephrectomy cases. Shock is the characteristic feature of surgically treated patients' symptom. All the 33 case of exploration was done without preliminary vascular pedicle control prior to opening the Gerota's fascia. Nephrectomy was done in 15 cases, and partial nephrectomy or renorrhaphy was done in 18 cases. Comparing the two groups, the former showed more shock rate (53.3 vs.33.3%), combined organ injuries (2.05 vs 1.32), and death rate (6.67 vs. 0%) (P<0.05). Gender ratio, patients' age and transfusion amount (2,984 vs 3,204ml.) did not show difference in both groups. The latter group took more time (98 vs. 128 min.) during operation. The causes of nephrectomy were renal pedicle injuries in 5 cases, shattered kidney in 7 cases and Grade III/V renal injuries with underlying anomalies in 2 cases (polycystic degeneration in one and hydronephrosis in the other case). One case was traumatic rupture of Wilms' tumor. In the management of traumatic renal injuries, patients who have more severe and associated organ injury, especially in the nephrectomy group, received surgical treatment. Shock is the only characteristic sign of surgical treatment group.