The Non-Operative Management of High-Grade Blunt Renal Trauma in Misurata Medical Center, Libya
DOI:
https://doi.org/10.54361/LJMR.20.1.05Keywords:
Renal injury, blunt trauma, conservative treatment, nephrectomyAbstract
Background: In trauma cases, genitourinary tract injuries occur in approximately 10% of cases, with renal trauma being the most common. Management of blunt renal trauma has evolved from operative to non-operative approaches over the last 30 years. Materials and Methods: This retrospective study evaluated the efficacy of non-operative management (NOM) for high-grade blunt renal trauma at Misurata Medical Center, Libya, from January 2016 to January 2018. Sixty-seven male patients (ages 25-67) were included. Results: The primary mechanisms of injury were road traffic accidents (52%), falls (28%), and fighting (20%), with most non-MVA injuries occurring during the 2016 war. The right kidney was more frequently affected (61%). The majority of injuries were Grade III and IV lacerations. Eighty-seven percent of patients presented with associated abdominal organ injuries. Two patients with Grade V injuries, who were hemodynamically unstable with active bleeding and associated liver trauma, underwent immediate nephrectomy. Crucially, the study found that renal injury grade was not a statistically significant predictor for operative management in hemodynamically stable patients. Short-term complications included urinary tract infections, hematuria, and abscesses. Mortality was not significant for stable patients. Conclusion: This study supports the increasing trend towards conservative management, demonstrating that NOM is largely successful for high-grade blunt renal trauma in hemodynamically stable patients, with a low failure rate and excellent renal salvage.
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