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Highgrade renal injury: nonoperative management of urinary extravasation and prediction of longterm outcomes Authors


JeanAlexandre Long, Gaelle Fiard, JeanLuc Descotes, Valentin Arnoux, Alexis ArvinBerod, icolas !errier, Bernard Boillot, $livier %&o'ron, )aroline !huillier, JeanJac+ues ,a-.eaud










First published: 23 $cto.er 2012Full 1u.lication histor2 DOI: 10.111134.14#454106.2012.11"(*.x

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JeanAlexandre Long, 7rolog2 De1art-ent, Greno.le 7niversit2 8os1ital, 3* 043 Greno.le )edex /, France. e -ail9 JALong:chu5greno.le.;r

%tud2 !21e < !hera12 =outco-es> 2.Level o; ?vidence What's no!n on the subject" and What does the study add" 8ighgrade renal trau-a see-s to .e eligi.le ;or conservative -anage-ent. 7reteric stent 1lace-ent raises issues a.out its use;ulness and its ti-ing. @redictive ;actors o; 1osttrau-a ;unction and surger2 need to .e &no'n.

7rinar2 extravasation is not associated 'ith 1oor ;unctional outco-e. 7reteric stenting is needed onl2 in case o; se1sis and ureteric clot retention. !he onl2 inde1endent 1redictor o; longter- renal ;unction is the i-1ortance o; devascularised renal ;rag-ents.


B!o 1redict the outco-es o; a nono1erative a11roach to -anaging urinar2 extravasation a;ter .lunt renal trau-a.

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BA 1ros1ective o.servational stud2 'as conducted .et'een Januar2 2004 and $cto.er 2011. Firstline nono1erative -anage-ent 'as 1ro1osed ;or // 1atients 1resenting 'ith a grade AV .lunt renal in4ur2 according to the revised A-erican Association ;or the %urger2 o; !rau-a =AA%!> classi;ication. A-ong the-, (2 1atients 1resented 'ith a urinar2 extravasation. BCanage-ent and outco-es 'ere recorded and co-1ared .et'een 1atients 1resenting and those 'ho did not 1resent 'ith urinar2 lea&age. ,elative 1osto1erative renal ;unction 'as assessed # -onths a;ter the trau-a using di-erca1tosuccinic acid renal scintigra1h2. B@redictors o; the need ;or endosco1ic or surgical -anage-ent and longter- renal ;unction 'ere evaluated on -ultivariate anal2sis.


BA-ong 1atients 'ith urinar2 lea&age, endosco1ic ureteric stent 1lace-ent and o1en surger2 'ere re+uired in 3(D and 1"D, res1ectivel2. B$n -ultivariate anal2sis, ;ever o; EF) and ureteric clot o.struction 'ere inde1endent 1redictors o; the need ;or ureteric stent 1lace-ent. !he onl2 1redictor o; o1en surger2 'as the 1ercentage o; devitalised 1arench2-a.3*." BLongter- renal ;unction loss 'as correlated to the 1ercentage o; devitalised 1arench2-a and associated visceral lesions. 7rinar2 extravasation did not 1redict surgical intervention or longter- renal ;unction loss.

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B7rinar2 extravasation a;ter .lunt renal trau-a can .e success;ull2 -anaged conservativel2 and does not 1redict longter- decreased renal ;unction or surger2 re+uire-ent. BA devascularised 1arench2-a volu-e o; E2"D 1redicts a higher rate o; surger2 and 1oorer renal ;unction