The contemporary management of traumatic renal injury at a UK major trauma centre
BAUS ePoster online library. Georgiades F. Jun 26, 2018; 211356
Fanourios Georgiades
Fanourios Georgiades
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Abstract
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Introduction: With the introduction of the Major Trauma Centre (MTC) network, there has been an increased exposure to renal injury; commonly in conjunction with polytrauma. Conservative management and advances in interventional radiology (IR) methods, reduces the rate of surgical exploration and preserves injured kidneys.

Aims: To analyse the success of contemporary management of renal injury following trauma in our MTC.

Materials and Methods: The prospectively maintained Trauma Audit and Research Network (TARN) database was interrogated to identify patients with urinary tract injuries between January 2014 and November 2016. Patients' records and imaging were reviewed to identify injury grades, interventions, outcomes and follow up.

Results: Renal injury was identified in 60 out of 78 patients with a urinary tract injury. Male to female ratio was 51:9. Average age was 37.5±17.36(1.5-94.6) years. The majority sustained blunt trauma 80% (N=48) compared to 20% penetrating (N=12). Injuries were; 12(20%) grade 1; 11(18.3%) grade 2; 17 (28.3%) grade 3; 12(20%) grade 4; 5(8.3%) grade 5 according to American Association for the Surgery of Trauma (AAST) scale. Early renal intervention occurred in 10 patients (16.6%), of which, 5 were managed with IR exclusively, 2 underwent open renal repair and 1 ureteric stenting. Emergency nephrectomy was performed in 2 patients (3.3%); both of whom died from extensive polytrauma. Overall 30-day mortality was 15% (n=9).

Conclusions: Even for haemodynamically unstable injuries, IR techniques were successful. Emergency nephrectomy remains a rare event even with polytrauma and laparotomy for associated injuries.
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