Читать книгу A Clinical Guide to Urologic Emergencies - Группа авторов - Страница 22

Of patients with blunt trauma that are managed non‐operatively, some will ultimately require intervention. One series evaluated 154 patients (74.8%) with grade IV and V blunt renal trauma, who were initially managed non‐operatively, with a non‐operative management failure rate of 7.8% [62]. The vast majority of the patients who failed non‐operative management did so because of their kidney injury and none of these patients had complications as a result of delayed operative management. The mean time to failure was just over 24 hours and the majority (83.3%) failed due to hemodynamic instability. Independent predictors based on multivariate analysis found that those who were older than 55 years of age or who were injured as a result of a motor vehicle collision were more likely to fail non‐operative management.

Patients with a devitalized parenchymal segment were more likely to require delayed surgical intervention in a series of grade IV and V blunt renal injuries [46]. Of 40 patients with grade III–V blunt renal injury initially managed non‐operatively, the risk of delayed nephrectomy in three was associated with grade IV injuries and secondary hemorrhage which necessitated intervention [8].