Nonoperative management of Renal Trauma

A recent patient with a Grade 4 Blunt Renal injury prompted us to consider nonoperative management.

Toutouzas, in Nonoperative Management of Blunt Rental Trauma: a prospective Study, Am Surg  2002, 68:1097-1103 studied 37 patients with blunt renal injury and varying grades of injury.
He concluded that:
"...NOM is the prevailing method of treatment after blunt renal trauma. It is successful in the majority of patients without peritonitis or hemodynamic instability and should be considered regardless of the severity of renal injury. "

A larger study from Baverstock, in Can J Urol 2001, 8: 1372-6 found that 77% of patients with grade 4 blunt renal injury were managed conservatively.  There were few long term complications.

Malcolm, in Nonoperative Management of Blunt Renal Trauma: Is routine early follow-up imaging necessary? , published in BMC Urol 2008, 8: looked at the need for follow-up imaging and concluded that:
"Grade IV renovascular injuries can be followed clinically without routine early follow-up imaging, but urine extravasation necessitates serial imaging to guide management decisions."