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J Urol. 1997 Jan;157(1):24-7.

Criteria for nonoperative treatment of significant penetrating renal lacerations.

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1
Department of Urology, University of California School of Medicine, San Francisco, USA.

Abstract

PURPOSE:

We developed criteria for nonoperative treatment of penetrating renal injuries and predicting which patients will benefit from immediate surgery.

MATERIALS AND METHODS:

We reviewed the records of 120 patients with grades 2 to 4 renal lacerations from gunshot and stab wounds, of whom 41 were treated nonoperatively (group 1) and 79 underwent immediate renal exploration (group 2).

RESULTS:

Group 1 had significantly lower incidences of gunshot wounds, shock, associated injuries, need for transfusion and high grade renal injuries. In patients with grade 2 lacerations no complications resulted from nonoperative treatment. However, 23.5% of patients in group 1 with grades 3 and 4 injuries had delayed renal bleeding versus none in group 2.

CONCLUSIONS:

Nonoperative treatment of penetrating renal lacerations is appropriate in hemodynamically stable patients without associated injuries. Grade 2 injuries can be treated nonoperatively but grades 3 and 4 injuries are associated with a significant risk of delayed bleeding if treated expectantly. Exploration should be considered if laparotomy is indicated for other injuries.

PMID:
8976207
[Indexed for MEDLINE]
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