Nonoperative management of blunt renal trauma: Is routine early follow-up imaging necessary?

• Main Authors: Malcolm John B, Derweesh Ithaar H, Mehrazin Reza, DiBlasio Christopher J, Vance David D, Joshi Salil, Wake Robert W, Gold Robert
• Format: Article
• Language: English
• Published: BMC 2008-09-01
• Series: BMC Urology
• Online Access: http://www.biomedcentral.com/1471-2490/8/11

<p>Abstract</p> <p>Background</p> <p>There is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma. We reviewed our experience with nonoperative management of blunt renal injuries in order to evaluate the utility of routine early follow-up imaging.</p> <p>Methods</p> <p>We reviewed all cases of blunt renal injury admitted for nonoperative management at our institution between 1/2002 and 1/2006. Data were compiled from chart review, and clinical outcomes were correlated with CT imaging results.</p> <p>Results</p> <p>207 patients were identified (210 renal units). American Association for the Surgery of Trauma (AAST) grades I, II, III, IV, and V were assigned to 35 (16%), 66 (31%), 81 (39%), 26 (13%), and 2 (1%) renal units, respectively. 177 (84%) renal units underwent routine follow-up imaging 24–48 hours after admission. In three cases of grade IV renal injury, a ureteral stent was placed after serial imaging demonstrated persistent extravasation. In no other cases did follow-up imaging independently alter clinical management. There were no urologic complications among cases for which follow-up imaging was not obtained.</p> <p>Conclusion</p> <p>Routine follow-up imaging is unnecessary for blunt renal injuries of grades I-III. Grade IV renovascular injuries can be followed clinically without routine early follow-up imaging, but urine extravasation necessitates serial imaging to guide management decisions. The volume of grade V renal injuries in this study is not sufficient to support or contest the need for routine follow-up imaging.</p>