Immediate radiologic and surgical management of renal injuries.

Urologic evaluation for renal trauma is usually delayed in the multiple-injured patient, since the management of life-threatening associated injuries takes precedence. A method of immediate radiologic diagnosis and surgical management was carried out in 1,205 patients with 1,222 renal injuries. Blunt external trauma caused 96% of the renal injuries. Immediate IVP resulted in a definitive diagnosis in 91% of the cases. The renal injuries comprised contusions in 87%, lacerations in 8%, rupture in 2%, and pedicle injuries in 3%. Associated injuries were present in 75.5% of patients, including 49% requiring a laparatomy for intra-abdominal injury. The overall nephrectomy rate of 3.7% compares favorably to the nephrectomy rate in studies reporting the conservative management of renal injuries.