Nephrectomy for traumatic renal injuries.

During a 16-year period 2,521 patients presented to our institution with renal trauma. Renal exploration was performed in 195 patients (202 renal units), with 31 units requiring exploration alone, 145 repair and 26 nephrectomy, yielding an overall nephrectomy rate of 13%. A detailed review of these 26 patients identified them as a unique population: all had major renal injuries, and as a group they demonstrated significantly higher rates of shock, injury severity scores, transfusion requirements and death rates than those in whom exploration with renal salvage was possible. In no case was nephrectomy required as a complication of exploration or attempted repair. In the properly staged patient undergoing surgery for appropriate indications with early vascular control exploration of renal injuries is safe. It is not the exploration that results in the nephrectomy but the injury itself.