Effect of an institutional policy of nonoperative treatment of grades I to IV XXXX .

@entity1 @entity8 @entity542 @entity1230 @entity811 @entity130
PURPOSE: Nonoperative treatment of serious @entity8 has been advocated and yet to our knowledge the optimum level of operative treatment has not been established to date. We report a unique data set, in which @entity1 with severe @entity8 were treated with an ultraconservative nonoperative approach during a period when urological consultation was not available at a major urban @entity130 center. MATERIALS AND METHODS: We retrospectively reviewed the charts of 51 @entity1 identified with renal @entity130 in the Detroit Receiving Hospital @entity130 data base from 1997 to 2001. RESULTS: Injuries were grades I to V in 15, 7, 11, 14 and 4 cases, respectively, and had a tendency toward @entity130 . Renorrhaphy was never performed. Nephrectomy was done sparingly, only for grade V @entity8 and only in @entity1 who were exsanguinating from the kidney. Two of the 4 @entity1 with grade V injury died of @entity1230 , including massive @entity542 . Only 2 of the @entity1 treated nonoperatively (4%) had complications, including fever and @entity811 in 1 each. CONCLUSIONS: This data set seems to support an ultraconservative approach of limiting renal surgery to only @entity1 with active exsanguination. The nephrectomy rate for 14 grade IV @entity130 , including some gunshot wounds to the kidney, was 0%. When comparing this rate with that in the literature, we would expect it to be 1 @entity1 to as high as 10. This approach was safe and resulted in a low complication rate of 4%. Series in which more aggressive therapy for @entity8 is advocated should compare favorably to ultraconservative therapy if aggressive therapy is to continue to be widely advocated.
