High Grade Blunt Renal XXXX : Predictors of Surgery and Long-Term Outcomes of Conservative Management. A Prospective Single Center Study.

@entity1 @entity8 @entity130 @entity1344
PURPOSE: The management of major @entity8 has shifted in the last decade in favor of a nonoperative approach. Our level 1 @entity130 center promotes this approach with the objective of renal function preservation. However, certain situations still require surgery. In this study we analyze predictors of surgery and long-term outcomes after conservative management. MATERIALS AND METHODS: From January 2004 to March 2015 we prospectively collected data from all @entity1 admitted to our institution for high grade blunt @entity8 (grades IV and V). Nonoperative management was considered successful when @entity1 did not undergo surgical exploration, regardless of angioembolization or endoscopic treatment. RESULTS: Of 306 @entity1 with @entity8 151 presented with major @entity130 , including 124 grade IV and 27 grade V. Nonoperative management was successful in 110 (89%) cases of grade IV and 14 (52%) cases of grade V lesions. Deceleration mechanism (p=0.03), associated lesions (p=0.001), percentage of devitalized parenchyma (p=0.012), angioembolization (p <0.001), @entity1344 (p <0.001) and low hemoglobin (p=0.001) were more frequent in @entity1 treated surgically. On multivariate analysis grade (OR 7.36, p=0.01) and @entity1344 (OR 4.18, p=0.04) were the only independent predictors of surgical treatment. Long-term followup of preserved kidneys revealed a remaining 40% and 0% relative renal function after grade IV and V @entity130 , respectively. Only devascularized parenchyma greater than 25% predicted the decline of long-term renal function. CONCLUSIONS: Nonoperative management can and should be performed safely in cases of grade IV @entity130 whenever possible, with valuable long-term renal function. It can also be initiated in grade V cases. However, surgeons should consider nephrectomy with the onset of any suspicious symptoms.
