Werner Zachary, Haffar Ahmad, Bacharach Emma, Knight-Davis Jennifer, Hajiran Ali, Luchey Adam
Department of Urology, West Virginia University, Morgantown, WV, USA.
School of Medicine, West Virginia University, Morgantown, WV, USA.
Res Rep Urol. 2022 Mar 17;14:79-85. doi: 10.2147/RRU.S349504. eCollection 2022.
Current urologic renal trauma guidelines favor conservative management. In 2012, we implemented an institution-wide renal trauma protocol to standardize management. This protocol details initiation of DVT (deep vein thrombosis) prophylaxis, cessation of bed rest, and frequency of laboratory studies. We hypothesized that low-grade injuries (grade I-III) could be managed without urologic consultation and that our chemical DVT prophylaxis regimen would not pose an increased risk of hemorrhage requiring transfusion.
We performed a cross-sectional analysis of a prospectively maintained database containing all renal trauma at our institution from 2009 to 2019. We segregated injuries based on grade, presence of multi-organ trauma, and evaluated the presence and types of intervention, initiation of chemical DVT prophylaxis, and post-DVT prophylaxis hemorrhage requiring transfusion.
We identified 295 cases of renal trauma, of which 62 were isolated injuries. Forty-three of the isolated renal injuries were transferred from outside facilities, 70% of which were classified as low-grade injuries. There were 220 low-grade lacerations and 75 high-grade lacerations. No grade I or II lacerations required any interventions. Two (2.5%) grade III lacerations required IR embolization. Twenty-five (41%) grade IV lacerations required intervention, of which five were nephrectomy. Seven (54%) grade V lacerations required intervention, of which 5 were nephrectomies. Upon review of our protocol with early ambulation and DVT prophylaxis, there were no cases of isolated renal injury where initiation of either treatment resulted in delayed hemorrhage requiring transfusion or surgical intervention.
Only 2/220 low-grade renal lacerations required intervention. Our data suggest that grade I and II renal lacerations can be managed safely without urologic consultation. Consultation is warranted for grade III injuries given the possibility of initial understaging. Furthermore, we believe our renal laceration protocol in our admittedly small, isolated sample has shown our DVT prophylaxis initiation to not pose increased risk.
当前的泌尿外科肾创伤指南倾向于保守治疗。2012年，我们实施了一项全院范围的肾创伤治疗方案以规范治疗。该方案详细说明了深静脉血栓形成（DVT）预防措施的启动、卧床休息的停止以及实验室检查的频率。我们假设低级别损伤（I - III级）无需泌尿外科会诊即可得到治疗，并且我们的化学性DVT预防方案不会增加需要输血的出血风险。
我们对一个前瞻性维护的数据库进行了横断面分析，该数据库包含了2009年至2019年我院所有的肾创伤病例。我们根据损伤级别、多器官创伤的存在情况对损伤进行分类，并评估干预措施的存在和类型、化学性DVT预防措施的启动以及DVT预防后需要输血的出血情况。
我们确定了295例肾创伤病例，其中62例为孤立性损伤。43例孤立性肾损伤是从外部机构转诊而来，其中70%被归类为低级别损伤。有220例低级别裂伤和75例高级别裂伤。没有I级或II级裂伤需要任何干预措施。2例（2.5%）III级裂伤需要介入放射栓塞治疗。25例（41%）IV级裂伤需要干预，其中5例进行了肾切除术。7例（54%）V级裂伤需要干预，其中5例进行了肾切除术。在回顾我们早期活动和DVT预防的方案时，没有孤立性肾损伤病例因启动任何一种治疗而导致需要输血或手术干预的延迟性出血。
只有2/220例低级别肾裂伤需要干预。我们的数据表明，I级和II级肾裂伤无需泌尿外科会诊即可安全治疗。鉴于可能存在初始分期不足的情况，III级损伤需要会诊。此外，我们认为在我们这个规模较小且孤立的样本中，我们的肾裂伤治疗方案表明启动DVT预防措施不会增加风险。
