Comparison of Nonoperative Management With Renorrhaphy and Nephrectomy in Penetrating Renal Injuries

Background: We reviewed our experience with penetrating renal injuries to compare nonoperative management of penetrating renal injuries with renorrhaphy and nephrectomy in light of concerns for unnecessary explorations and increased nephrectomy rates. Methods: In this retrospective study, we reviewed the records of 98 penetrating renal injuries from 2003 to 2008. Renal injuries were classified according to the American Association for the Surgery of Trauma and analyzed based on nephrectomy, renorrhaphy, and nonoperative management. Patient characteristics and outcomes measured were compared between management types. Continuous variables were summarized by means and compared using t test. Categorical variables were compared using chi(2) test. Results: Nonoperative management was performed in 40% of renal injuries, followed by renorrhaphy (38%) and nephrectomy (22%). Of renal gunshot wounds (n = 79), 26%, 42%, and 32% required nephrectomy, renorrhaphy, and were managed nonoperatively, respectively. No renal stab wound (n = 16) resulted in a nephrectomy and 81% were managed conservatively. Renal injuries managed nonoperatively had a lower incidence of transfusion (34 vs. 95%, p < 0.001), shorter mean intensive care unit (ICU) (3.0 vs. 9.0 days, p = 0.028) and mean hospital length of stay (7.9 vs. 18.1 days, p = 0.006), and lower mortality rate (0 vs. 20%, p = 0.005) compared with nephrectomy but similar to renorrhaphy (transfusion: 34 vs. 36%, p = 0.864; mean ICU: 3.0 vs. 2.8 days, p = 0.931; mean hospital length of stay: 7.9 vs. 11.2 days, p = 0.197; mortality: 0 vs. 6%, p = 0.141). The complication rate of nonoperative management was favorable compared with operative management. Conclusions: Selective nonoperative management of penetrating renal injuries resulted in a lower mortality rate, lower incidence of blood transfusion, and shorter mean ICU and hospital stay compared with patients managed by nephrectomy but similar to renorrhaphy. Complication rates were low and similar to operative management.