262 / Urology

injury. Segmental vascular injuries with or without collecting system injury are
classified as grade IV. Regardless of the staging system, a hemodynamically
unstable patient who does not require exploration for other organ injuries embolization can effectively control bleeding. The end point with main renal artery
embolization is essentially the same as that with exploration and nephrectomy.
The major limitation of this study is that the authors follow-up is solely based
on a patient questionnaire. None of the patients had a physical examination or
laboratory test to assess renal function. There is no radiographic follow-up
after initial hospital discharge. Based on this, we can conclude that embolization
is safe in the short term and does not seem to be associated with any clinically
apparent long-term sequelae.
D. E. Coplen, MD

Revision of Current American Association for the Surgery of Trauma Renal

Injury Grading System
Buckley JC, McAninch JW (Lahey Clinic Med Ctr, Burlington, MA; San
Francisco General Hosp, CA)
J Trauma 70:35-37, 2011

Background.dWe propose a revision of the original 1989 renal organ

injury system established by the American Association for the Surgery of
Trauma based on our institutions >25-year longitudinal experience. Our
goal is to expand the current grading system to include segmental vascular
injuries and ureteral pelvic injuries and to establish a more rigorous definition of severe grade IV and V renal injuries.
Methods.dWe retrospectively reviewed our prospectively gathered
contiguous renal database of 3,580 renal injuries to describe a revised
renal grading injury scale based on clinical renal salvage outcomes. We
focused on the mechanism of injury, the stability of the patient, radiographic
imaging, associated nonrenal injuries, and clinical salvage outcome data.
Results.dNo changes were made in the definition of grade I to III injuries.
The revised grade IV classification includes all collecting system, renal pelvis
injuries and segmental arterial and/or venous injuries. The revised grade V
classification is limited to main renal artery and/or vein injuries, including
laceration, avulsion, and thrombosis. We compared the nephrectomy rate
and clinical renal salvage rate between the original 1989 renal organ injury
system with our revised renal injury staging classification.
Conclusion.dThe revised renal injury staging classification provides
complete and clear definitions of renal trauma while still performing its
fundamental objective to reflect increasingly complex renal injuries.
Uniform language and classification of renal injuries will enhance discussion, clinical investigation, and research of renal trauma.
:

The authors revise the renal injury staging classification. Improved imaging
technology allows more accurate identification of the location and severity of
renal injury. There is no collecting system injury in grades I, II, and III injuries.

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In grade III injury, the renal laceration is greater than 1 cm and into the renal
medulla. Grade IV is now any collecting system injury or segmental venous or
arterial injury. Previously, grade V was the somewhat nebulous shattered
kidney. It now includes only vascular injuries to the renal pedicle. A kidney
with grade V injury is almost never salvageable because of time delays between
injury and evaluation. Because most renal injuries are grade I, this new classification will likely impact only the management of the most serious renal
injuries.
D. E. Coplen, MD