Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study.

Autor: Hakam N; Department of Urology, University of California San Francisco, San Francisco, CA, USA., Keihani S; Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA., Shaw NM; Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA.; Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC, USA., Abbasi B; Department of Urology, University of California San Francisco, San Francisco, CA, USA., Jones CP; Department of Urology, University of California San Francisco, San Francisco, CA, USA., Rogers D; Department of Radiology, University of Utah, Salt Lake City, UT, USA., Wang SS; Department of Radiology, University of Utah, Salt Lake City, UT, USA., Gross JA; Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA., Joyce RP; Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA., Hagedorn JC; Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA., Selph JP; Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA., Sensenig RL; Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA., Moses RA; Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA., Dodgion CM; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA., Gupta S; Department of Urology, University of Kentucky, Lexington, KY, USA., Mukherjee K; Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA., Majercik S; Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA., Smith BP; Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA., Broghammer JA; University of Kansas Medical Center, Kansas City, KS, USA., Schwartz I; Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA., Baradaran N; Department of Urology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA., Zakaluzny SA; Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA., Erickson BA; Department of Urology, University of Iowa, Iowa City, IA, USA., Miller BD; Department of Urology, Detroit Medical Center, Detroit, MI, USA., Askari R; Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA., Carrick MM; Medical City Plano, Plano, TX, USA., Burks FN; Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA., Norwood S; Department of Surgery, UT Health Tyler, Tyler, TX, USA., Myers JB; Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA., Breyer BN; Department of Urology, University of California San Francisco, San Francisco, CA, USA. Benjamin.Breyer@ucsf.edu.; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. Benjamin.Breyer@ucsf.edu.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2023 Jul; Vol. 41 (7), pp. 1983-1989. Date of Electronic Publication: 2023 Jun 25.
DOI: 10.1007/s00345-023-04432-w
Abstrakt: Purpose: To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management.
Methods: We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery).
Results: Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25-50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found.
Conclusion: Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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