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

Nizar Hakam; Sorena Keihani; Nathan M Shaw; Behzad Abbasi; Charles P Jones; Douglas Rogers; Sherry S Wang; Joel A Gross; Ryan P Joyce; Judith C Hagedorn; J Patrick Selph; Rachel L Sensenig; Rachel A Moses; Christopher M Dodgion; Shubham Gupta; Kaushik Mukherjee; Sarah Majercik; Brian P Smith; Joshua A Broghammer; Ian Schwartz; Nima Baradaran; Scott A Zakaluzny; Bradley A Erickson; Brandi D Miller; Reza Askari; Matthew M Carrick; Frank N Burks; Scott Norwood; Jeremy B Myers; Benjamin N Breyer; Multi-institutional Genito-Urinary Trauma Study Group (MiGUTS)

doi:10.1007/s00345-023-04432-w

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

World J Urol. 2023 Jul;41(7):1983-1989. doi: 10.1007/s00345-023-04432-w. Epub 2023 Jun 25.

Authors

Nizar Hakam¹, Sorena Keihani², Nathan M Shaw^{3

4}, Behzad Abbasi¹, Charles P Jones¹, Douglas Rogers⁵, Sherry S Wang⁵, Joel A Gross⁶, Ryan P Joyce⁶, Judith C Hagedorn⁷, J Patrick Selph⁸, Rachel L Sensenig⁹, Rachel A Moses¹⁰, Christopher M Dodgion¹¹, Shubham Gupta¹², Kaushik Mukherjee¹³, Sarah Majercik¹⁴, Brian P Smith¹⁵, Joshua A Broghammer¹⁶, Ian Schwartz¹⁷, Nima Baradaran¹⁸, Scott A Zakaluzny¹⁹, Bradley A Erickson²⁰, Brandi D Miller²¹, Reza Askari²², Matthew M Carrick²³, Frank N Burks²⁴, Scott Norwood²⁵, Jeremy B Myers², Benjamin N Breyer^{26

27}; Multi-institutional Genito-Urinary Trauma Study Group (MiGUTS)

Affiliations

¹ Department of Urology, University of California San Francisco, San Francisco, CA, USA.
² Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
³ Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA.
⁴ Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
⁵ Department of Radiology, University of Utah, Salt Lake City, UT, USA.
⁶ Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
⁷ Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
⁸ Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁹ Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA.
¹⁰ Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
¹¹ Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
¹² Department of Urology, University of Kentucky, Lexington, KY, USA.
¹³ Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
¹⁴ Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
¹⁵ Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
¹⁶ University of Kansas Medical Center, Kansas City, KS, USA.
¹⁷ Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA.
¹⁸ Department of Urology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
¹⁹ Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA.
²⁰ Department of Urology, University of Iowa, Iowa City, IA, USA.
²¹ Department of Urology, Detroit Medical Center, Detroit, MI, USA.
²² Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
²³ Medical City Plano, Plano, TX, USA.
²⁴ Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
²⁵ Department of Surgery, UT Health Tyler, Tyler, TX, USA.
²⁶ Department of Urology, University of California San Francisco, San Francisco, CA, USA. [email protected].
²⁷ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. [email protected].

PMID: 37356027
DOI: 10.1007/s00345-023-04432-w

Abstract

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.

Keywords: Kidney trauma; Nephrectomy; Nonoperative management; Urologic trauma.

Publication types

Multicenter Study

MeSH terms

Adult
Humans
Injury Severity Score
Kidney / surgery
Middle Aged
Multiple Trauma*
Nephrectomy
Retrospective Studies
Trauma Centers*
Urogenital System / injuries