SURGICAL INTERVENTIONS IN KIDNEY TRAUMA: CONTEMPORARY TECHNIQUES AND CLINICAL OUTCOMES

Abstract

Kidney trauma is a major cause of urological morbidity and it presents complicated issues in the management of patients both in the acute and long term. The development of diagnostic imaging, critical care, interventional radiology, and surgical practices have significantly changed the practice of renal trauma, where practice currently shifts towards selective intervention and renal preservation. This review gives an overall picture of modern surgical procedures in kidney trauma, focusing on the indicators of surgery, new operating methods, and related clinical and renal functional results. The current evidence is in favour of the use of standardized systems of injury grading and contrast-enhanced computed tomography in order to inform management decisions. Although non-operative management and angioembolization have become the preferred forms of treatment in a large number of full stable patients, surgery is still necessary in situations of hemodynamic instability, complicated vascular injury, or failure of non-operative therapy. Contemporary surgical practices will focus on nephron-saving methods whenever possible because there is a close relationship between nephron mass loss, acute kidney injury, and chronic kidney disease in the long run. There are special clinical situations such as paediatric trauma, solitary or transplanted kidneys and polytrauma that need specific management approaches. Perioperative renal function is closely correlated with clinical outcomes, and the acute kidney injury turns out to be a major factor of short- and long-term outcomes. This review of the existing literature indicates the best practice areas in surgical management and future research areas to focus on improving the outcomes of kidney trauma patients and their renal preservation.