Journal article
Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study
World journal of urology, Vol.41(7), pp.1983-1989
07/2023
DOI: 10.1007/s00345-023-04432-w
PMID: 37356027
Abstract
To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management.
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).
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.
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.
Details
- Title: Subtitle
- Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study
- Creators
- Nizar Hakam - University of California, San FranciscoSorena Keihani - University of UtahNathan M Shaw - MedStar Georgetown University HospitalBehzad Abbasi - University of California, San FranciscoCharles P Jones - University of California, San FranciscoDouglas Rogers - University of UtahSherry S Wang - University of UtahJoel A Gross - University of WashingtonRyan P Joyce - Harborview Medical CenterJudith C Hagedorn - University of WashingtonJ Patrick Selph - University of Alabama at BirminghamRachel L Sensenig - Cooper University HospitalRachel A Moses - Dartmouth–Hitchcock Medical CenterChristopher M Dodgion - Medical College of WisconsinShubham Gupta - University of KentuckyKaushik Mukherjee - Loma Linda University Medical CenterSarah Majercik - Intermountain Medical CenterBrian P Smith - Hospital of the University of PennsylvaniaJoshua A Broghammer - University of Kansas Medical CenterIan Schwartz - Hennepin County Medical CenterNima Baradaran - The Ohio State University Wexner Medical CenterScott A Zakaluzny - University of California Davis Medical CenterBradley A Erickson - University of IowaBrandi D Miller - Detroit Medical CenterReza Askari - Brigham and Women's HospitalMatthew M Carrick - Plano Cancer InstituteFrank N Burks - Oakland UniversityScott Norwood - The University of Texas Health Science Center at TylerJeremy B Myers - University of UtahBenjamin N Breyer - University of California, San FranciscoMulti-institutional Genito-Urinary Trauma Study Group (MiGUTS)
- Resource Type
- Journal article
- Publication Details
- World journal of urology, Vol.41(7), pp.1983-1989
- DOI
- 10.1007/s00345-023-04432-w
- PMID
- 37356027
- eISSN
- 1433-8726
- Language
- English
- Electronic publication date
- 06/25/2023
- Date published
- 07/2023
- Academic Unit
- Urology
- Record Identifier
- 9984438959802771
Metrics
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