We reviewed 113 patients of renal trauma between may, 1989 and May, 1995 to clarify the characterisitcs of the patients who need surgical management.
Of the 113 renal trauma patients, 80 were treated conservatively and remaining 33 were treated with surgically. The causes of injury were blunt trauma in 112 and penetrating injury with gunshot in 1. The grade of injury was contusion in 48
(42.5%),
simple laceration in 25 (22.1%), deep laceration into collecting system in 26 (23.0%), shattered kidney in 7 (6.2%), and pedicle injuries in 7 (6.2%). Aside from 1 case of graded 2 Wilms' tumor patient, all the surgically treated patients were
over
grade 3. Surgically treated patients had more associated trauma, especially in nephrectomy cases. Shocjk is the characteristic feature of surgically treated patinets' symptom. All the 33 cases of exploration was done without preliminary vascular
pedicle
control prior to opening the Gerota's fascia. Nephrectomy was done in 15 cases, and partial nephrectomy or renorrhaphy was done in 18 cases. Comparing the two groups, the former showed more shock rate (53.3 vs.33.3%), combined organ injuries
(2.05
vs
1.32), and death rate (6.67 vs. 0%) (p<0.05). Gender ratio, patientss' age and transfusion amotnt (2,984 vs. 3,204ml.) did not show difference in both groups. The causes of nephrectomy were renal pedicle injuries in 5 cases, shattered kidney in 7
cases
and Grade III/V renal injuries with underlying anomalies in 2 cases (polycystic degeneration in one and hydronephrosis in the other case). One case was traumatic rupture of Wilms' tumor.
In the management of traumatic renal injuries, patients who have more severe and associated organ injury, especially in the nephrectomy group, received surgical treatment. Shock is the only characteristic sign of surgical treatment group.
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