Operative management of renal injuries: parenchymal and vascular.

The decision to operate on a traumatized kidney should be made primarily on the basis of severity of injury to the kidney. Expanding or pulsatile retroperitoneal hematomas continue to be absolute indications for renal exploration. While parenchymal injuries, including severe parenchymal injuries, can usually be repaired, vascular injuries are generally less amenable to repair. Main renal arterial injuries should be repaired only if there is a solitary kidney injury or a bilateral main renal artery injury. Such tools as the American Association for the Surgery of Trauma renal organ injury scale can help the urologist in managing injuries and in salvaging kidneys that would otherwise be removed.