Renal trauma: an overview of current management.

BACKGROUND

Following liver and splenic injury, the kidney is the third most common abdominal organ to be injured and is frequently associated with injuries to other organs. Management has shifted to conservative treatment, which is associated with increased organ preservation. The urologist, as part of a multi-disciplinary team, must review the clinical status, associated organ injuries and imaging findings to decide how to intervene.

OBJECTIVES

To provide an overview of the current management strategies and guidelines for renal trauma.

METHODS

A comprehensive literature review on renal trauma was conducted using the PubMed and Google Scholar databases, with a focus on recent findings and the latest guideline recommendations.

RESULTS

Sound clinical decision-making is required when selecting a management strategy. Selective non-operative management has become the new standard in haemodynamically stable patients. Advances in imaging, endoscopy and endovascular treatment have shifted the management of renal trauma towards minimally invasive approaches. Urinary diversion is reserved for cases with complications due to urinary extravasation. Renorrhaphy must be performed in suitable cases.

CONCLUSION

Selective non-operative management has been embraced as the new standard in renal trauma, with a resultant decreased nephrectomy rate. The urologist must take all factors into account to identify those that may lead to adverse outcomes and to intervene promptly.