The role of non-operative management for high-grade renal injuries

Authors

Emily M. Kokush, Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, USA. emk207@njms.rutgers.edu.
Kunj Jain, Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, USA.
John Fastenau, Department of Urology, George Washington University School of Medicine, Washington, DC, USA.
Aleksander Popovic, Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, USA.
Meher Pandher, Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, USA.
Alexis M. Driscoll, Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, USA.
Robert E. Weiss, Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, USA.
Evan Kovac, Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, USA.
Ziad C. Sifri, Division of Trauma, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Amjad Alwaal, Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Room G1680, Newark, NJ, USA.

Document Type

Journal Article

Publication Date

3-5-2025

Journal

International urology and nephrology

DOI

10.1007/s11255-025-04434-0

Keywords

Conservative treatment; Kidney; Minimally invasive surgery; Postoperative complications; Trauma

Abstract

PURPOSE: This study aimed to investigate the long-term outcomes of non-operative, operative, and minimally invasive surgery management of high-grade renal injuries (Grades III-V) in an underserved population at a high-volume trauma center. METHODS: We conducted a retrospective chart review of 93 patients who sustained high-grade renal trauma and presented to University Hospital, a Level 1 trauma center, between 2017 and 2022. The patients were categorized by initial management strategy: non-operative, operative, or minimally invasive surgery (endoscopic urologic and interventional radiologic procedures). Outcome variables included length of hospital stay, complications, mortality, long-term renal function, and the need for additional procedures. We analyzed associations between management strategies and outcomes, adjusting for injury mechanism and severity. RESULTS: Non-operative management was the most common strategy (60%), followed by operative (20%) and minimally invasive surgery (20%). Operative management was associated with a higher rate of complications and reoperations (p = 0.007) and significantly longer hospital stays (p < 0.001). Non-operative management demonstrated similar long-term renal function compared to operative and minimally invasive approaches (p = 0.087), with fewer complications. No non-operative patients required subsequent procedural management, while 32% of those initially managed operatively or minimally invasively required additional interventions. CONCLUSIONS: Non-operative management is a safe and effective approach for hemodynamically stable patients with high-grade renal trauma, leading to fewer complications and similar long-term renal outcomes compared to operative and minimally invasive strategies. These findings support renal preservation through non-operative management, especially in underserved populations.

APA Citation

Kokush, Emily M.; Jain, Kunj; Fastenau, John; Popovic, Aleksander; Pandher, Meher; Driscoll, Alexis M.; Weiss, Robert E.; Kovac, Evan; Sifri, Ziad C.; and Alwaal, Amjad, "The role of non-operative management for high-grade renal injuries" (2025). GW Authored Works. Paper 6854.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6854

Department

Urology