Renal salvage in penetrating kidney injuries: a prospective analysis

BACKGROUND: Routine exploration of penetrating kidney injuries is not advised because of the fear of a higher nephrectomy rate. This study was conducted to assess the efficacy of renal salvage in patients who underwent routine exploration of the injured kidney and to document complications related to the procedure. METHODS: This was a prospective study over a 2-year period. RESULTS: Fifty patients (46 male and 4 female patients), median age 29 years (range, 16-69 years), were included. Mechanisms of injury were gunshot wound in 43 patients (86%) and stab wounds in 7 patients (14%). Mean Revised Trauma Score was 10.5. All patients underwent laparotomy. Three injuries were bilateral, for a total of 53 renal units. There were three deaths on the operating table (two nephrectomies and one bilateral repair). Management of the remaining 49 renal units was as follows: simple drainage in 13 (26.5%), renal repair in 17 (35%), partial nephrectomy in 6 (12%), and nephrectomy in 13 (26.5%). There were two minor complications directly related to the renal salvage: transient hypertension in one patient and a urine leak, which settled on conservative management. CONCLUSION: An overall renal salvage rate of 73.5% for penetrating trauma was achieved with routine exploration of the injured kidney.