The Role of Non-Operative Management in Severe Renal Injuries: Do All Grade V Injuries Necessitate Intervention?

Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of Urology


NTRODUCTION AND OBJECTIVE: Non-operative management has become standard for most renal trauma. Little data exists regarding conservative management of American Association for the Surgery of Trauma (AAST) grade V injuries. We aim to evaluate management of grade V renal trauma, focusing on feasibility and safety of non-operative management. METHODS: Grade V renal trauma cases submitted with avail-able imaging from 21 Level-1 trauma centers through the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We report management patterns categorized as expectant (observation with no interventions),conservative(performing kidney angioembolization, or stent / neph-rostomy tube / perirenal drain placement), or operative (performing kidney related surgical interventions).RESULTS: 21 cases were independently radiologically verified as grade V cases by the 2018 AAST classification and were included in analysis. Most were males (15; 71%) with blunt trauma (20; 95%) and median age was 34 years (IQR 25-29). Most common management approach was operative (8, 38%), followed by conservative (7, 33%)and expectant (6, 29%). All those operatively management had nephrectomy, with 2 having a failed angioembolization attempt before nephrectomy. 4 out of 7 patients in the conservative group had angioembolization and the other 3 had a stent or drainage tube. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size, laceration size and proportion of cases with>50% and>95% devascularization (Table 1). Vascular contrast extravasation tended to be higher in operatively managed patients, but was not statistically significant. CONCLUSIONS: There is a significant role for non-operative management for grade V renal trauma, particularly in those with blunt trauma and are stable enough to undergo imaging.





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American Urological Association Annual Meeting, April 28 - May 1, 2023, Chicago, IL