Top

European Journal of Trauma and Emergency Surgery

Published in:

22-11-2021 | Computed Tomography | Original Article

Evaluation of urinary extravasation after non-operative management of traumatic renal injury: a multi-center retrospective study

Authors: Arisa Muratsu, Shunichiro Nakao, Jumpei Yoshimura, Takashi Muroya, Junya Shimazaki, Yuko Nakagawa, Hiroshi Ogura, Takeshi Shimazu

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

Abstract

Purpose

Urinary extravasation is one of the major complications after non-operative management of traumatic renal injury and may lead to urinary tract infection and sepsis. The purpose of this study was to evaluate these factors in patients with traumatic renal injury.

Methods

This was a multi-center, retrospective, observational study performed at three tertiary referral hospitals in Osaka prefecture. We included patients with traumatic renal injury transported to the centers between January 2008 and December 2018. We excluded patients who either died or underwent nephrectomy within 24 h after admission. We investigated the occurrence of urinary extravasation and the related factors after traumatic renal injury using multivariable logistic regression analysis.

Results

In total, 146 patients were eligible for analysis. Their median age was 44 years and 68.5% were male. Their median Injury Severity Score was 17. Renal injuries were graded as American Association for Surgery of Trauma (AAST) grade I in 33 (22.6%), II in 27 (18.5%), III in 38 (26.0%), IV in 28 (19.2%), and V in 20 (13.7%) patients. Urinary extravasation was diagnosed in 26 patients (17.8%) and was statistically significantly associated with AAST grades IV–V (adjusted odds ratio, 33.8 [95% confidence interval 7.12–160], p < 0.001).

Conclusion

We observed urinary extravasation in 17.8% of patients with non-operative management of traumatic renal injury and the diagnosed was made in mostly within 7 days after admission. In this study, the patients with AAST grade IV–V injury were associated with having urinary extravasation.

Available only for authorised users

McClung CD, Hotaling JM, Wang J, Wessells H, Voelzke BB. Contemporary trends in the immediate surgical management of renal trauma using a national database. J Trauma Acute Care Surg. 2013;75:602–6. https://doi.org/10.1097/TA.0b013e3182a53ac2.CrossRefPubMed

Wright JL, Nathens AB, Rivara FP, Wessells H. Renal and extrarenal predictors of nephrectomy from the national trauma data bank. J Urol. 2006;175:970–5. https://doi.org/10.1016/S0022-5347(05)00347-2.CrossRefPubMed

Santucci RA, Fisher MB. The literature increasingly supports expectant (conservative) management of renal trauma—a systematic review. J Trauma. 2005;59:493–503. https://doi.org/10.1097/01.ta.0000179956.55078.c0.CrossRefPubMed

van der Wilden GM, Velmahos GC, Joseph DK, Jacobs L, Debusk MG, Adams CA, Gross R, Burkott B, Agarwal S, Maung AA, et al. Successful nonoperative management of the most severe blunt renal injuries: a multicenter study of the research consortium of New England Centers for Trauma. JAMA Surg. 2013;148(10):924–31. https://doi.org/10.1001/jamasurg.2013.2747.CrossRefPubMed

Keihani S, Anderson RE, Fiander M, McFarland MM, Stoddard GJ, Hotaling JM, Myers JB. Incidence of urinary extravasation and rate of ureteral stenting after high-grade renal trauma in adults: a meta-analysis. Transl Androl Urol. 2018;7(Suppl 2):S169–78. https://doi.org/10.21037/tau.2018.04.13.CrossRefPubMedPubMedCentral

Long JA, Fiard G, Descotes JL, Arnoux V, Arvin-Berod A, Terrier N, Boillot B, Skowron O, Thuillier C, Rambeaud JJ. High-grade renal injury: non-operative management of urinary extravasation and prediction of long-term outcomes. BJU Int. 2012;111:249–55. https://doi.org/10.1111/j.1464-410X.2012.11578.x.CrossRef

Gill B, Palmer LS, Reda E, Franco I, Kogan SJ, Levitt SB. Optimal renal preservation with timely percutaneous intervention: a changing concept in the management of blunt renal trauma in children in the 1990s. Br J Urol. 1994;74(3):370–4. https://doi.org/10.1111/j.1464-410x.1994.tb16629.x.CrossRefPubMed

Fiard G, Rambeaud JJ, Descotes JL, Boillot B, Terrier N, Thuillier C, Chodez M, Skowron O, Berod AA, Arnoux V, et al. Long-term renal function assessment with dimercapto-succinic acid scintigraphy after conservative treatment of major renal trauma. J Urol. 2012;187:1306–9. https://doi.org/10.1016/j.juro.2011.11.103.CrossRefPubMed

Davis KA, Reed RL 2nd, Santaniello J, Abodeely A, Esposito TJ, Poulakidas SJ, Luchette F. Predictors of the need for nephrectomy after renal trauma. J Trauma. 2006;60(1):164–9. https://doi.org/10.1097/01.ta.0000199924.39736.36.CrossRefPubMed

10.

Keihani S, Xu Y, Presson AP, Hotaling JM, Nirula R, Piotrowski J, Dodgion CM, Black CM, Mukherjee K, Morris BJ, Genito-Urinary Trauma Study Group, et al. Contemporary management of high-grade renal trauma: results from the American Association for the Surgery of Trauma Genitourinary Trauma study. J Trauma Acute Care Surg. 2018;84(3):418–25. https://doi.org/10.1097/TA.0000000000001796.CrossRefPubMed

11.

Shariat SF, Roehrborn CG, Karakiewicz PI, Dhami G, Stage KH. Evidence-based validation of the predictive value of the American Association for the Surgery of Trauma kidney injury scale. J Trauma. 2007;62:933–9. https://doi.org/10.1097/TA.0b013e318031ccf9.CrossRefPubMed

12.

Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRef

13.

Bolorunduro OB, Villegas C, Oyetunji TA, Haut ER, Stevens KA, Chang DC, Cornwell EE 3rd, Efron DT, Haider AH. Validating the Injury Severity Score (ISS) in different populations: ISS predicts mortality better among Hispanics and females. J Surg Res. 2011;166(1):40–4. https://doi.org/10.1016/j.jss.2010.04.012.CrossRefPubMed

14.

Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, Flint LM, Gennarelli TA, Malangoni MA, Ramenofsky ML, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989;29(12):1664–6.CrossRef

15.

Nakao S, Katayama Y, Hirayama A, Hirose T, Ishida K, Umemura Y, Tachino J, Kiguchi T, Matsuyama T, Kiyohara K, et al. Trends and outcomes of blunt renal trauma management: a nationwide cohort study in Japan. World J Emerg Surg. 2020;15:50. https://doi.org/10.1186/s13017-020-00329-w.CrossRefPubMedPubMedCentral

16.

Hotaling JM, Wang J, Sorensen MD, Rivara FP, Gore JL, Jurkovich J, McClung CD, Wessells H, Voelzke BB. A national study of trauma level designation and renal trauma outcomes. J Urol. 2012;187(2):536–41. https://doi.org/10.1016/j.juro.2011.09.155.CrossRefPubMed

17.

McInerney D, Jones A, Roylance J. Urinoma. Clin Radiol. 1977;28:345–51.CrossRef

18.

Blankenship JC, Gavant ML, Cox CE, Chauhan RD, Gingrich JR. Importance of delayed imaging for blunt renal trauma. World J Surg. 2001;25:1561–4. https://doi.org/10.1007/s00268-001-0150-0.CrossRefPubMed

19.

Shirazi M, Sefidbakht S, Jahanabadi Z, Asadolahpour A, Afrasiabi MA. Is early reimaging CT scan necessary in patients with grades III and IV renal trauma under conservative treatment? J Trauma. 2010;68(1):9–12. https://doi.org/10.1097/TA.0b013e3181ad5835.CrossRefPubMed

20.

Alsikafi NF, McAninch JW, Elliott SP, Garcia M. Nonoperative management outcomes of isolated urinary extravasation following renal lacerations due to external trauma. J Urol. 2006;176(6):2494–7. https://doi.org/10.1016/j.juro.2006.08.015.CrossRefPubMed

21.

Davis P, Bultitude MF, Koukounaras J, Royce PL, Corcoran NM. Assessing the usefulness of delayed imaging in routine follow-up for renal trauma. J Urol. 2010;184(3):973–7. https://doi.org/10.1016/j.juro.2010.04.070.CrossRefPubMed

22.

Malcolm JB, Derweesh IH, Mehrazin R, DiBlasio CJ, Vance DD, Joshi S, Wake RW, Gold R. Nonoperative management of blunt renal trauma: is routine early follow-up imaging necessary? BMC Urol. 2008;8:11. https://doi.org/10.1186/1471-2490-8-11.CrossRefPubMedPubMedCentral

23.

Bayne DB, Tresh A, Baradaran N, Murphy G, Osterberg EC, Ogawa S, Wenzel J, Hampson L, McAninch J, Breyer B. Does routine repeat imaging change management in high-grade renal trauma? Results from three level 1 trauma centers. World J Urol. 2019;37(7):1455–9. https://doi.org/10.1007/s00345-018-2513-2.CrossRefPubMed

24.

Hardee MJ, Lowrance W, Stevens MH, Nirula R, Brant WO, Morris SE, Myers JB. Process improvement in trauma: compliance with recommended imaging evaluation in the diagnosis of high-grade renal injuries. J Trauma. 2013;74(2):558–62. https://doi.org/10.1097/TA.0b013e31827d5d5a.CrossRef

Title: Evaluation of urinary extravasation after non-operative management of traumatic renal injury: a multi-center retrospective study
Authors: Arisa Muratsu
Shunichiro Nakao
Jumpei Yoshimura
Takashi Muroya
Junya Shimazaki
Yuko Nakagawa
Hiroshi Ogura
Takeshi Shimazu
Publication date: 22-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Hematuria
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01825-7

ACC 2024 Congress

Springer Medicine

Evaluation of urinary extravasation after non-operative management of traumatic renal injury: a multi-center retrospective study

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2022

Conservative treatment of ulnar styloid fractures following volar-plate fixation of distal radius fractures: incidence of nonunion evaluated by computed tomography

The pace of a trauma resuscitation: experience matters

Local application reduces number of needed EPC for beneficial effects on wound healing compared to systemic treatment in mice

A long-term experience with Mutars tumor megaprostheses: analysis of 187 cases

Dexmedetomidine and paralytic exposure after damage control laparotomy: risk factors for delirium? Results from the EAST SLEEP-TIME multicenter trial

Alginate scaffolds improve functional recovery after spinal cord injury