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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVES, METHODS, RESULTS. Meshes: Adolescent, Adult, Female, Hematoma, Humans, Injury Severity Score, Kidney, Length of Stay, Male, Middle Aged, Nephrectomy, Postoperative Complications, Retrospective Studies, Treatment Outcome, Urinary Fistula, Wounds, Nonpenetrating.
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Management of major blunt renal lacerations: is a nonoperative approach indicated? Context: The aim of the study was to determine whether a nonoperative approach is able to reduce renal parenchymal loss after renal trauma. Sixty-four consecutive patients with major blunt renal lacerations were treated from 1988 to 1999. Initial management was conservative. In group 1 (35 patients) delayed hemorrhage, persistent urinoma or hemodynamic instability were dealt with by open surgery. In group 2 (29 patients), most complications were dealt with using endoscopic procedures; open surgery was reserved exclusively for major complications. In group 1, 7 patients were not operated and 28 patients were managed surgically. Twenty (57%) patients underwent total (8) or partial (12) nephrectomy. In 8 patients the surgical intervention was open drainage of perinephric collection (6) and/or renorrhaphies (2). Four patients in this group developed urinary fistulae treated successfully with ureteral stents. Length of hospital stay was 9.6 days (3-25 days). In group 2, persistent hemodynamic instability led to nephrectomy in 1 case. The remaining 28 patients were managed conservatively, with endoscopic ureteric stenting in 5 cases. A persistent urinary extravasation with hyperthermia led to open drainage of perinephric urinoma (5) and renorrhaphy (2). No delayed nephrectomy was necessary. Average hospital stay was 12 days (5-21 days). Only 1 patient in this group developed hypertension.
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For most patients and with close follow-up available, conservative treatment represents a real alternative to open surgery in major blunt renal lacerations. In our experience, open surgery usually results in loss of renal parenchyma.