8/12/2019 Highgrade renal injury non operative management of urinary extravasation and prediction of long term outcomes

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Highgrade renal injury: nonoperative management ofurinary extravasation and prediction of longtermoutcomes

Authors

JeanAlexandre Long,1.

Gaelle Fiard,1.

JeanLuc Descotes,2.

Valentin Arnoux,

3.

Alexis ArvinBerod,4.

icolas !errier,".

Bernard Boillot,#.

$livier %&o'ron,(.

)aroline !huillier,

*.

JeanJac+ues a-eaud/.

First published: 23 $ctoer 2012Full ulication histor

DOI: 10.1111.14#454106.2012.11"(*.x

)iting literature

JeanAlexandre Long, 7rolog Deart-ent, Grenole 7niversit 8osital, 3* 043 Grenole )edex /, France. e-ail9JALong:chu5grenole.;r

Astract%tud !e < !hera =outco-es>

2 Level o; ?vidence

What's no!n on the subject" and What does the study add"8ighgrade renal trau-a see-s to e eligile ;or conservative -anage-ent. 7reteric stentlace-ent raises issues aout its use;ulness and its ti-ing. @redictive ;actors o; osttrau-a;unction and surger need to e &no'n.

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8/12/2019 Highgrade renal injury non operative management of urinary extravasation and prediction of long term outcomes

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7rinar extravasation is not associated 'ith oor ;unctional outco-e. 7reteric stenting isneeded onl in case o; sesis and ureteric clot retention. !he onl indeendent redictor o;longter- renal ;unction is the i-ortance o; devascularised renal ;rag-ents.

$BJ?)!V?

!o redict the outco-es o; a nonoerative aroach to -anaging urinar

extravasation a;ter lunt renal trau-a.

@A!?!% AD C?!8$D%

A rosective oservational stud 'as conducted et'een Januar 2004 and

$ctoer 2011. Firstline nonoerative -anage-ent 'as roosed ;or // atients resenting'ith a grade V lunt renal inur according to the revised A-erican Association ;or the%urger o; !rau-a =AA%!> classi;ication. A-ong the-, (2 atients resented 'ith a urinarextravasation.

Canage-ent and outco-es 'ere recorded and co-ared et'een atients

resenting and those 'ho did not resent 'ith urinar lea&age. elative ostoerative renal

;unction 'as assessed # -onths a;ter the trau-a using di-ercatosuccinic acid renal

scintigrah. @redictors o; the need ;or endoscoic or surgical -anage-ent and longter- renal

;unction 'ere evaluated on -ultivariate analsis.

?%7L!%

A-ong atients 'ith urinar lea&age, endoscoic ureteric stent lace-ent and

oen surger 'ere re+uired in 3( and 1", resectivel. $n -ultivariate analsis, ;ever o; E) and ureteric clot ostruction 'ere

indeendent redictors o; the need ;or ureteric stent lace-ent. !he onl redictor o; oensurger 'as the ercentage o; devitalised arench-a. 3*."

Longter- renal ;unction loss 'as correlated to the ercentage o; devitalised

arench-a and associated visceral lesions. 7rinar extravasation did not redict surgicalintervention or longter- renal ;unction loss.

)$)L7%$%

7rinar extravasation a;ter lunt renal trau-a can e success;ull -anaged

conservativel and does not redict longter- decreased renal ;unction or surgerre+uire-ent.

A devascularised arench-a volu-e o; E2" redicts a higher rate o; surger

and oorer renal ;unction