Clinical Challenges in Trauma Surgery: Renal Trauma

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 13 April 2023

⏱️ 30 minutes

🔗️ Recording | iTunes | RSS

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Summary

To operate or not to operate, to drain the urine leak or to not drain it, those are the questions. Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan- in their final episode together! - as they discuss how to navigate the ins and outs of renal trauma!

Learning Objectives:
· Define the different renal injury grades and how to manage each,
· Identify when to take the renal trauma patient to the operating room,
· Discuss when to involve IR for urinary drainage or embolization.
· Explain when and how to perform a nephrectomy.
· Debate the treatment of penetrating zone two injuries- to explore or not explore?

Quick Hits:
1. Most kidney injuries, the vast majority, can be non-operatively managed.
2. For pretty much all AAST grade of injury, the choice to go to the OR immediately lies in whether the patient is stable or unstable.
3. If there is a urinary leak seen on imaging, it can usually just be observed and followed with repeat imaging to determine the need for drainage, unless the injury is significant or if there is injury to the renal pelvis- then the patient will usually need a drainage procedure.
4. Consider IR in any stable patient found to have active extravasation, fistula, or pseudoaneurysm.
5. In the case of an unstable patient, except very rare circumstances, you should be going to the OR
6. If there is another cause of instability, address that first. If you’re opening Gerota’s fascia, be prepared to commit to a nephrectomy.
7. In penetrating injury, the formal teaching is mandatory exploration of a renal hematoma. Real world experience shows that this isn’t always necessary- such as in tangential injuries or injuries to the periphery- on a case-by-case basis.

References
1. Federico C, Moore Ernest E, Yoram K, Walter B, Aari L, Yosuke M, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019;14:54.
2. Morey AF, Brandes S, Dugi DD 3rd et al: Urotrauma: AUA guideline. J Urol 2014, 192: 327. Published 2014; Amended 2017, 2020.
3. Aziz HA, Bugaev N, Baltazar G, Brown Z, Haines K, Gupta S, Yeung L, Posluszny J, Como J, Freeman J, Kasotakis G. Management of adult renal trauma: a practice management guideline from the eastern association for the surgery of trauma. BMC Surg. 2023 Jan 27;23(1):22. doi: 10.1186/s12893-023-01914-x. PMID: 36707832; PMCID: PMC9881253.
4. Petrone P, Perez-Calvo J, Brathwaite CEM, Islam S, Joseph DK. Traumatic kidney injuries: A systematic review and meta-analysis. Int J Surg. 2020 Feb;74:13-21. doi: 10.1016/j.ijsu.2019.12.013. Epub 2019 Dec 21. PMID: 31870753.

**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7

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If you liked this episode, check out other trauma surgery episodes here: https://behindtheknife.org/podcast-category/trauma/

Transcript

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0:00.0	Behind the Night, the surgery podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Have you been working hard to dominate your surgical residency?
0:26.0	Do you want to help others to dominate no matter what stage of training they're in?
0:30.0	Hi to all of our BTK listeners. My name's Nina Clark, General Surgery resident at the University of Washington.
0:36.0	And I'm Jessica Mallard, General Surgery resident at the University of Michigan.
0:39.0	We both have had the privilege of working as behind-the-knife education fellows for the past year, and we're excited to continue growing our team.
0:46.0	Are you a surgical resident interested and enthusiastic about surgical education?
0:51.0	BTK is offering a two-year surgical education fellowship starting July 1, 2023 and ending June 30, 2025.
0:59.0	Only residents who are starting a two-year block, a professional development time, away from full-time clinical activity will be considered.
1:06.0	And you have to ensure that your institution and mentor approve of this fellowship.
1:11.0	Fellows will be deeply involved in the BTK activities.
1:14.0	The two of us have worked on an absite revamp, not tying video series, our new trauma video atlas, and a comprehensive student resource just to start.
1:23.0	While this is an unpaid internship, you'll have access to the all of the behind-the-knife resources, like illustrators, editors, recording and video equipment, and more to help make high-quality surgical education content.
1:35.0	Applications are due April 16th, and you can find the link to the application in our show notes or on our Twitter page at Behind the Knife.
1:43.0	You can also contact us at hello at behind-the-knife.org with any questions.
1:48.0	We've had a great time so far this year, and there's only more to come.
1:52.0	We hope you'll consider joining us.
1:54.0	Hey, everyone. The Miami trauma team is back for another episode of Clinical Challenges and Trauma Surgery.
2:00.0	Our team consists of me, Eva Rechiga, a PGY4, Yuri Neiman, who is now an attending in Tel Aviv Medical Center in Israel, but was previously a trauma fellow here at University of Miami.
2:12.0	And Rishi Ratan, our attending advisor, who is now at Legacy Emanuel in Portland, Oregon.
2:17.0	Today, we will be discussing a topic that is ever-changing and confusing in renal trauma.
2:23.0	First off, upwards of 95% of injuries to the kidney are managed nonoperatively, and not all urine leaks equal a trip to the operating room.
	...

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