Background and Objectives: Non-operative managements have been increasingly favored for high-grade renal traumas. Our aim was to compare the outcomes of conservative and interventional managements of Grades 3-5 renal traumas.
Materials and Methods: Prospective studying of the patients who presented to our hospital with Grades 3-5 renal trauma between October 2015 and March 2017. They were classified into Group A for conservative management and Group B for interventional management with comparisons for the demographic and clinical variables and outcomes.
Results: A total of 63 patients presented with Grades 3-5 renal trauma within the duration of the study. Group A and B included 49 and 14 patients, respectively, with comparable demographic characteristics. Blunt trauma was mainly due to motor vehicle accidents (39.7%) and represented >87% of all cases. Distribution of the grades of renal trauma was represented in Group A and B as Grade-3 in 17 and 1 patient(s), Grade-4 in 17 and 7 patients, and Grade-5 in 15 and 6 patients, respectively. Conservative management was successful in 43 cases (87.8%), while it failed in six cases which indicated surgical interventions up to nephrectomy. In Group B, interventions included nephrectomy, renorrhaphy, angioembolization for persistent hemorrhage, JJ stent insertion, and combined JJ stent with nephrostomy tube insertion for the drainage of collection in 6 (42.9%), 3 (21.4%), 2 (14.3%), 2 (14.3%), and 1 (7.1%) patient(s), respectively. Blood transfusion rate was significantly higher in Group B (0.57 ± 0.89 vs. 2.07 ± 1.00; P = 0.000), while hospital stay was insignificantly longer in Group A (P = 0.066).
Conclusions: Conservative management could be applied successfully for significant proportions of high Grades 3-5 renal trauma in the hemodynamically stable patients with significant reduction of the rate of nephrectomy. However, surgical interventions are still warranted for certain indications with relatively high possibilities of nephrectomy.