Abstract
Purpose
This study aimed to identify the characteristics associated with the need for urinary intervention for a blunt renal injury with collection system involvement using a computed tomography (CT) protocol for trauma.
Materials and Methods
Abdominal CT images of patients with blunt renal injuries from 2016 to 2020 were reviewed. Patients with low-grade renal trauma, non-collecting system involvement, American Association for the Surgery of Trauma grade V shattered kidney, and emergent nephrectomy were excluded. The largest perinephric mass thickness was measured in the axial view using CT, and a cutoff value was obtained using a receiver-operating characteristic curve analysis. Risk factors for further urinary intervention were analyzed.
Results
Among the 70 patients included in this study, those with perinephric mass thicknesses < 25 mm (n = 36) had a significantly lower rate of urinary intervention than those with perinephric mass thicknesses ≥ 25 mm (0 vs. 5; p = 0.023). There was no significant difference in the follow-up durations of the groups (19 days vs. 38 days; p = 0.198). More than 90% of the perinephric mass in the < 25 mm group resolved within a median follow-up duration of 38 days, whereas nearly half of the ≥ 25 mm group had a residual perinephric mass during a median follow-up duration of 19 days.
Conclusion
The initial CT protocol for trauma was useful for predicting the need for further urinary interventions for collecting system injuries. A perinephric mass thickness < 25 mm is predictive of a low likelihood of requiring urinary intervention.
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Data availability
The datasets analyzed during the current study are not publicly available due to institutional policy but are available from the corresponding author upon reasonable request.
Abbreviations
- AAST:
-
American Association for the Surgery of Trauma
- AUA:
-
American Urological Association
- AUC:
-
Areas under the ROC curve
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- CT:
-
Computed tomography
- EAU:
-
European Association of Urology
- ED:
-
Emergency department
- GU:
-
Genitourinary
- HGRT:
-
High-grade renal trauma
- ICU LOS:
-
Length of stay in intensive care unit stay
- ISS:
-
Injury Severity Score
- LOS:
-
Length of stay in hospital
- ROC:
-
Receiver operating characteristic
- RTS:
-
Revised Trauma Score
- SD:
-
Standard Deviation
- TAE:
-
Trans-arterial embolization
- TRISS:
-
Trauma Injury Severity Score
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Acknowledgements
The authors thank Yu-Ching Wang for the statistical assistance and acknowledge the support of the Maintenance Project of the Center for Big Data Analytics and Statistics (grant CLRPG3N0011) at Chang Gung Memorial Hospital for study design and monitoring and data analysis and interpretation.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Po-Ting Lin: Data collection, data analysis, manuscript writing. Yu-Hsiang Lin: Project development, manuscript editing Yu-San Tee: Project development, data analysis, manuscript editing. Chi-Tung Cheng: Project development, data analysis. Chien-Hung Liao: Project development. Chi-Hsun Hsieh: Project development. Chih-Yuan Fu: Project development, data collection.
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Lin, PT., Lin, YH., Tee, YS. et al. Does a collecting system injury with grade iv renal blunt trauma always need urinary intervention?. World J Urol 42, 15 (2024). https://doi.org/10.1007/s00345-023-04710-7
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DOI: https://doi.org/10.1007/s00345-023-04710-7