Maria Galindo Alins (Madrid / ES), María Dolores Pérez Díaz (Madrid / ES), Carlos Morales García (Madrid / ES), Laura Cebolla Rojas (Madrid / ES), Melanie Morote González (Madrid / ES), Cristina Rey Valcárcel (Madrid / ES), Fernando Turégano Fuentes (Madrid / ES)
Abstract text (incl. references and figure legends)
Introduction:
The kidney is the most frequently injured genitourinary organ in trauma patients. Partial nephrectomy has been described classically as a therapeutic option. Our aim was to review the use of partial nephrectomy in our practice. Our hypothesis is that this technique is almost never performed despite its continued description and teaching in trauma manuals and courses.
Material and Methods:
Retrospective observational study based on a Level I Trauma Center prospective registry of severe trauma (1993-2022).Demographic data, trauma mechanism, injury severity, hospital management and outcomes were analyzed with SPSS version 25.
Results:
We analyzed 176 patients with kidney injuries, 85.5% due to blunt trauma. Trauma mechanisms were: collisions (23%), falls from a heigh (22.5%), MVA
(18.5%), run overs (13.5%), stab wounds (11.5%), fire arm injuries (2%) and bull horn injuries (1%).The Shock Index (SI) median on arrival was 0.8 (IQR0.37).The RTS mean was 10.9 (SD 1.8) and the ISS median was 22 (IQR18) and the NISS was27 (IQR18).
There were 6 (3%) bilateral lesions, 74 right and 99 left. We"ve found hilum lesions in 14 patients (8%), left kidney burst in 4 (2%) and 1 (0.5%) burst on right.
42% of left lesions were associated with splenic injury and 66% of right with hepatic injury.
In 158 patients (88%) NOM was indicated, in 41(23%) an angiography was performed and 15 (8.5%) were embolized. This strategy succeeds in 154 patients (97%), failure was related in four cases. In 16 (9%) patients a total nephrectomy was performed, in 2 (2%) hemostatic surgical techniques were performed. There has been no partial nephrectomy in our sample.
Conclusion:
In our experience renal trauma NOM was effective in more than 97% of the cases.Total nephrectomy was the surgical technique performed in all unstable patients.
Partial nephrectomies were not performed at all.Partial nephrectomy due to trauma seems more like a myth than a clinical reality.
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