Diagnosis and treatment of closed renal trauma / 中华泌尿外科杂志

ABSTRACT

Objective To improve the diagnosis and management of closed renal trauma,and to reduce the rate of nephrectomy. Methods A total of 189 cases (146 men and 43 women; mean age,38 years) of closed renal trauma were retrospectively studied. A variety of examinations, including urinary analysis, B-ultrasonography, intravenous urography( IVU) and CT,were used for the diagnosis in these patients. Among them,closed renal trauma was accompanied by celiac viscera injury in 27 cases,by encephalic injury in 5, by fractures of spine and limbs in 13,and by compound trauma and shock in 3. Of the 189 cases, 156 were treated with conservative therapy, including 3 of spleen rupture,2 of encephalic injury,7 of fracture of spine and limbs;27 cases were treated with operation, including 15 with kidney repair,5 with partial nephrectomy, 7 with nephrectomy;3 cases were treated with selective renal artery embolization. Results Three patients with severe closed renal trauma died of compound trauma and shock soon after admission,and the other 186 patients recovered. Of them, 102 cases were followed up from 3 months to 8 years. Among patients undergoing conservative treatment renal hypertension occurred in 3 cases, urinoma in 1 , kidney atrophy in 1 and local hydronephrosis in 1. In patients undergoing surgery or selective kidney artery embolization, no subsequent complication occurred. Conclusions CT scan can provide a major basis for the diagnosis and treatment choice as well as early detection of urinoma of closed renal trauma. For closed renal trauma below grade IV ,conservative treatment is the better option.