Question

How to managed recovering patients from a nephrectomy secondary to kidney trauma?

Answer 1

-- There is no consensus on the optimal management of high grade renal trauma.Delayed surgery increases the likelihood of secondary hemorrhage and persistent urinary extravasation.

-- Majority of high grade renal injuries can be managed conservatively.Grade five injuries and the need for more packed cell transfusions during resuscitations predict the need for emergency intervention.

TREATMENT:-

-- Regardless of injury grade,all patients who were hemodynamically stable after resuscitation were considered candidates for conservative management.

-- Patients who had ongoing hemodynamic instability despite blood transfusion and resuscitation,who had expanding hematoma and who had a pulsatile retroperitoneal hematoma were considered for immediate exploratory laparotomy.

-- Conservative management considered of bed rest,analgesia,hydration and broad spectrum antibiotics in the presence of urinoma.

-- Patients treated conservatively were followed up with continuous hemodynamic monitoring,serial hematocrit determination and abdominal girth measurement.

-- Routine reimagining after 48 hours was not obtained in every patients .

-- The indications for repeat imaging were urinary leak and ongoing hemorrhage.

-- Strict bed rest was advised until the gross hematuria resolved and patients were discharged after 3-4 days of ambulation and uneventful hospital stay.