Research article

Nonoperative management of blunt renal trauma: Is routine early follow-up imaging necessary?

John B Malcolm^1* , Ithaar H Derweesh^1,3* , Reza Mehrazin¹ , Christopher J DiBlasio¹ , David D Vance¹ , Salil Joshi² , Robert W Wake^1,3 and Robert Gold^1,2

¹  Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee, USA

²  Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA

³  Urology Service, Elvis Presley Memorial Trauma Center, Regional Medical Center at Memphis, Tennessee, USA

author email corresponding author email* Contributed equally

BMC Urology 2008, 8:11doi:10.1186/1471-2490-8-11

Published:	3 September 2008

Abstract

Background

There is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma. We reviewed our experience with nonoperative management of blunt renal injuries in order to evaluate the utility of routine early follow-up imaging.

Methods

We reviewed all cases of blunt renal injury admitted for nonoperative management at our institution between 1/2002 and 1/2006. Data were compiled from chart review, and clinical outcomes were correlated with CT imaging results.

Results

207 patients were identified (210 renal units). American Association for the Surgery of Trauma (AAST) grades I, II, III, IV, and V were assigned to 35 (16%), 66 (31%), 81 (39%), 26 (13%), and 2 (1%) renal units, respectively. 177 (84%) renal units underwent routine follow-up imaging 24–48 hours after admission. In three cases of grade IV renal injury, a ureteral stent was placed after serial imaging demonstrated persistent extravasation. In no other cases did follow-up imaging independently alter clinical management. There were no urologic complications among cases for which follow-up imaging was not obtained.

Conclusion

Routine follow-up imaging is unnecessary for blunt renal injuries of grades I-III. Grade IV renovascular injuries can be followed clinically without routine early follow-up imaging, but urine extravasation necessitates serial imaging to guide management decisions. The volume of grade V renal injuries in this study is not sufficient to support or contest the need for routine follow-up imaging.