Pd31-02 Grade Iv Penetrating Renal Injuries Are Associated With Higher Rates of Delayed Intervention for Urinary Extravasation as Compared to Blunt Renal Injuries

You have accessJournal of UrologyReconstruction: External Genitalia and Urotrauma (including transgender surgery and traumatic fistula) I (PD31)1 May 2024PD31-02 GRADE IV PENETRATING RENAL INJURIES ARE ASSOCIATED WITH HIGHER RATES OF DELAYED INTERVENTION FOR URINARY EXTRAVASATION AS COMPARED TO BLUNT RENAL INJURIES Bryn M. Launer, Matthew W. Cole, George Koch, Leah Chisholm, and Niels V. Johnsen Bryn M. LaunerBryn M. Launer , Matthew W. ColeMatthew W. Cole , George KochGeorge Koch , Leah ChisholmLeah Chisholm , and Niels V. JohnsenNiels V. Johnsen View All Author Informationhttps://doi.org/10.1097/01.JU.0001009432.48553.4f.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of high grade renal trauma continues to evolve. While observation is often preferred in blunt renal trauma, hemodynamic instability and concomitant injuries in penetrating renal trauma can lead to immediate surgical intervention. This study compares the rate of immediate and delayed interventions for urinary extravasation (UE) for penetrating vs blunt grade IV renal trauma. METHODS: The study included 934 patients who sustained high grade, defined as American Association for the Surgery of Trauma (AAST) grade III-V renal trauma from 2005 to 2023 at a single level 1 trauma center. Of these, 126 sustained grade IV renal trauma. Demographic and outcomes data were collected retrospectively. AAST grade was determined via radiologist plus urologist review of admission computed tomography scans. RESULTS: Of the 126 patients with grade IV renal trauma, 35 presented with penetrating trauma, while 91 had blunt trauma. Median age was 30.5 years, 58% were male. Penetrating trauma patients were significantly younger and more likely to be male (Table 1). Overall, 32.5% of patients underwent immediate intervention, with significantly more penetrating trauma patients undergoing immediate intervention as compared to blunt. Specifically, 28.6% of penetrating patients and 11.0% of blunt had interventions related to UE on presentation (p=0.03). During index admission, 32% of penetrating trauma patients who did not have immediate intervention ultimately underwent delayed intervention (stent, nephrectomy, or renorrhaphy) for collecting system injuries, as compared to 7.4% of blunt trauma (Table 1). On multivariate analysis adjusting for injury severity score, patients with penetrating injuries with UE initially managed conservatively were 3.9 times more likely to undergo delayed intervention as compared to conservatively managed blunt trauma patients (OR 3.9, 1.24-12.95). CONCLUSIONS: This study demonstrates a higher rate of delayed intervention for initially conservatively managed grade IV penetrating renal injuries with UE compared to blunt injuries. While penetrating injuries to the collecting system may be safely managed without intervention, this study highlights the lower success rate of conservative management for UE in this population. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e630 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Bryn M. Launer More articles by this author Matthew W. Cole More articles by this author George Koch More articles by this author Leah Chisholm More articles by this author Niels V. Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...