scholarly journals Evaluation of urinary extravasation after non-operative management of traumatic renal injury: a multi-center retrospective study

2021 ◽  
Author(s):  
Arisa Muratsu ◽  
Shunichiro Nakao ◽  
Jumpei Yoshimura ◽  
Takashi Muroya ◽  
Junya Shimazaki ◽  
...  
Keyword(s):  
Renal Injury ◽  
Injury Severity ◽  
Operative Management ◽  
Multivariable Logistic Regression Analysis ◽  
Related Factors ◽  
Referral Hospitals ◽  
Osaka Prefecture ◽  
Urinary Extravasation ◽  
Non Operative Management ◽  
Made In

Abstract Purpose Urinary extravasation is one of the major complications after non-operative management of traumatic renal injury and may lead to urinary tract infection and sepsis. The purpose of this study was to evaluate these factors in patients with traumatic renal injury. Methods This was a multi-center, retrospective, observational study performed at three tertiary referral hospitals in Osaka prefecture. We included patients with traumatic renal injury transported to the centers between January 2008 and December 2018. We excluded patients who either died or underwent nephrectomy within 24 h after admission. We investigated the occurrence of urinary extravasation and the related factors after traumatic renal injury using multivariable logistic regression analysis. Results In total, 146 patients were eligible for analysis. Their median age was 44 years and 68.5% were male. Their median Injury Severity Score was 17. Renal injuries were graded as American Association for Surgery of Trauma (AAST) grade I in 33 (22.6%), II in 27 (18.5%), III in 38 (26.0%), IV in 28 (19.2%), and V in 20 (13.7%) patients. Urinary extravasation was diagnosed in 26 patients (17.8%) and was statistically significantly associated with AAST grades IV–V (adjusted odds ratio, 33.8 [95% confidence interval 7.12–160], p < 0.001). Conclusion We observed urinary extravasation in 17.8% of patients with non-operative management of traumatic renal injury and the diagnosed was made in mostly within 7 days after admission. In this study, the patients with AAST grade IV–V injury were associated with having urinary extravasation.

scholarly journals Evaluation of Urinary Extravasation After Non-Operative Management of Traumatic Renal Injury: A Multi-Center Retrospective Study

2021 ◽  
Author(s):  
Arisa Muratsu ◽  
Shunichiro Nakao ◽  
Jumpei Yoshimura ◽  
Takashi Muroya ◽  
Junya Shimazaki ◽  
...  
Keyword(s):  
Renal Injury ◽  
Injury Severity ◽  
Operative Management ◽  
Multivariable Logistic Regression Analysis ◽  
Related Factors ◽  
Referral Hospitals ◽  
Osaka Prefecture ◽  
Urinary Extravasation ◽  
Non Operative Management ◽  
Made In

Abstract Background: Urinary extravasation is one of the major complications after non-operative management of traumatic renal injury and may lead to urinary tract infection and sepsis. However, there is a paucity of research on timing of the occurrence or the risk factors of urinary extravasation among patients with traumatic renal injury. The purpose of this study was to evaluate these factors in patients with traumatic renal injury.Methods: This was a multi-center, retrospective, observational study performed at three tertiary referral hospitals in Osaka prefecture. We included patients with traumatic renal injury transported to the centers between January 2008 and December 2018. We excluded patients who either died or underwent nephrectomy within 24 hours after admission. We investigated the occurrence of urinary extravasation and the related factors after traumatic renal injury using multivariable logistic regression analysis.Results: In total, 146 patients were eligible for analysis. Their median age was 44 years and 68.5% were male. Their median Injury Severity Score was 17. Renal injuries were graded as American Association for Surgery of Trauma (AAST) grade I in 33 (22.6%), II in 27 (18.5%), III in 38 (26.0%), IV in 28 (19.2%), and V in 20 (13.7%) patients. Urinary extravasation was diagnosed in 26 patients (17.8%) and was statistically significantly associated with AAST grades IV-V (adjusted odds ratio, 33.8 [95% confidence interval, 7.12–160], p<0.001).Conclusion: We observed urinary extravasation in 17.8% of patients with non-operative management of traumatic renal injury and the diagnosed was made in mostly within 7 days after admission. In this study, the patients with AAST grade IV-V injury were associated with having urinary extravasation.

High-grade renal injury: non-operative management of urinary extravasation and prediction of long-term outcomes

2012 ◽  
Vol 111 (4b) ◽  
pp. E249-E255 ◽  
Author(s):  
Jean-Alexandre Long ◽  
Gaelle Fiard ◽  
Jean-Luc Descotes ◽  
Valentin Arnoux ◽  
Alexis Arvin-Berod ◽  
...  
Keyword(s):  
Renal Injury ◽  
Operative Management ◽  
High Grade ◽  
Long Term Outcomes ◽  
Urinary Extravasation ◽  
Non Operative Management

13 HIGH GRADE RENAL INJURY: NON OPERATIVE MANAGEMENT OF URINARY EXTRAVASATION AND PREDICTION OF LONG-TERM OUTCOMES

2013 ◽  
Vol 189 (4S) ◽  
Author(s):  
Jean-Alexandre Long ◽  
Gaelle Fiard ◽  
Jean-Luc Descotes ◽  
Olivier Skowron ◽  
Valentin Arnoux ◽  
...  
Keyword(s):  
Renal Injury ◽  
Operative Management ◽  
High Grade ◽  
Long Term Outcomes ◽  
Urinary Extravasation ◽  
Non Operative Management

scholarly journals Traumatic Liver Injury in Hong Kong: The Management Strategy and Outcome

2009 ◽  
Vol 16 (4) ◽  
pp. 208-216 ◽  
Author(s):  
CN Chong ◽  
YS Cheung ◽  
KF Lee ◽  
TH Rainer ◽  
BSP Lai
Keyword(s):  
Hong Kong ◽  
Liver Injury ◽  
Hospital Stay ◽  
Injury Severity ◽  
Road Traffic ◽  
Demographic Data ◽  
Operative Management ◽  
Concomitant Injuries ◽  
Significant Difference ◽  
Non Operative Management

Introduction Management of liver injury is challenging and evolving. The aim of this article is to review the outcome of traumatic liver injury in Chinese people in Hong Kong. Materials & methods Records of 40 patients with hepatic injury who received treatment at the Prince of Wales Hospital between December 2000 and May 2005 were reviewed. Demographic data, severity of liver injury, Injury Severity Score (ISS), haemodynamic status and Glasgow Coma Scale (GCS) score on admission, investigations made, concomitant injuries, management scheme, and outcome of patients were analysed. Results There were 23 male and 17 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (65%). Half of the patients were treated by non-operative management (NOM). None of them required surgery during subsequent management. Patients in the operative management (OM) group had a significantly higher ISS (p=0.026), but there was no significant difference in the mortality rate between the OM and NOM groups. Patients with stable haemodynamic status and who were treated non-operatively had a significantly shorter hospital stay (p=0.006). High grade liver injury (OR=8.0, 95% CI=1.2 to 53.8, p=0.03) and ISS greater than 25 (OR=21.6, 95% CI=2.0 to 225.3, p=0.01) were independent risk factors for mortality on multivariate analysis. Conclusions Non-operative management of liver injury can be safely accomplished in haemodynamically stable patients, with the possible benefit of a shorter hospital stay.

scholarly journals Non-Operative Management for Renal and Splenic Trauma – A Case Report

2020 ◽  
Vol 13 (62) (2) ◽  
pp. 43-52
Author(s):  
Alexandru Georgian Lăculiceanu ◽  
Denis Anamaria Mereț ◽  
Ruxandra Rotaru ◽  
Mircea Daniel Hogea ◽  
Ioan Scârneciu
Keyword(s):  
Injury Severity ◽  
Left Kidney ◽  
Operative Management ◽  
Renal Trauma ◽  
Iliopsoas Muscle ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Grade Ii ◽  
Non Operative Management

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma  is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

scholarly journals Successful Non-operative Management of Grade IV Penetrating Renal Injury: A Case Report

2011 ◽  
Vol 6 (1) ◽  
pp. 1-3
Author(s):  
Mohsen Kalhor ◽  
S. Ameneh Sabzi ◽  
Mehdi Molaei
Keyword(s):  
Case Report ◽  
Renal Injury ◽  
Operative Management ◽  
Non Operative Management

scholarly journals Renal Shell injuries with Retaining renal shell fragments due to improvised explosive devices. Acute conservative approach and long term follow-up

2021 ◽  
Author(s):  
Murat Zor ◽  
Bahadir Topuz ◽  
Engin Kaya ◽  
Sercan Yilmaz ◽  
Sinan Akay ◽  
...  
Keyword(s):  
Renal Injury ◽  
Medical Records ◽  
Operative Management ◽  
Complication Rates ◽  
Long Term Follow Up ◽  
Grade 3 ◽  
One Year ◽  
Non Operative Management ◽  
Shell Fragments

Abstract Introduction: Among penetrating injuries, renal shrapnel injuries consist of a rarity of renal gunshot injuries. Due to the paucity of cases reported in the literature, there is no consensus regarding the management of renal shrapnel injuries and retaining renal shell fragments. In this study we aimed to report our non-operative management experience of renal shrapnel injuries who had also retaining renal shell fragments.Material and Methods: We retrospectively evaluated the medical records of renal shrapnel injuries that had also retaining renal shell fragments. All hemodynamically stable patients managed non-operatively and included to the study. The medical records of age, renal injury grade according to AAST, presenting pulse, systolic blood pressure, transfusion requirement, complications and need for adjuvant procedures, non-operative management success and mortality was reviewed. Complication rates due to retaining renal shell fragments were assessed by interviewing via telephone at the end of the first year of injury. The patients asked for plumbism symptoms and any surgical intervention for these foreign bodies.Results: A total of 8 patients with retaining renal shell fragments due to renal shrapnel injuries were included to the study. Mean patient age was 27,8 years. Mean follow-up period was 38.7±15.1 months. All patients were male. AAST renal injury scores were grade 1 one, grade 2 two, grade 3 four, grade 4 one patient. All patients were successfully managed non-operatively and discharged on the 7th day without any complication. No symptoms of plumbism and surgery necessity secondary to retaining renal shell fragments were seen in at least one year follow-up.Conclusion: Our study demonstrates that non-operative management of renal shrapnel injuries with retaining renal shell fragments lead low complication rates and high chance of renal preservation. However, we must keep in mind that this kind of management is safe in experienced trauma centers that have experienced staff.

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