Blunt kidney trauma involving the renal collecting system: management strategy

Introduction. Renal trauma accounts for 2–10% of all injuries to the urinary system. The optimal management strategy for renal trauma with collecting system rupture remains controversial. Over the past decade, accumulating evidence has demonstrated the high efficacy of non‑operative management (NOM) in this setting. Objective. To determine the optimal management approach for blunt renal trauma with collecting system rupture. Materials & methods. From 1998 to 2023, 43 patients with blunt renal trauma complicated by collecting system rupture were treated at the Dzhanelidze Research Institute of Emergency Medicine. The severity of renal injury was graded according to the American Association for the Surgery of Trauma (AAST) classification. The severity of traumatic shock was assessed using the Y.N. Tsibin scoring system. Patients were divided into two groups. Management strategies for blunt renal trauma with collecting system rupture included both conservative and surgical approaches. Results. The median age of the patients was 43 years (interquartile range 35 – 55), and the male-to-female ratio was 32:11. In the prospective group, most patients received conservative (n = 12) or minimally invasive (n = 9) treatment, whereas in the retrospective group all patients (n = 21) underwent open surgery. The nephrectomy rate was higher in the retrospective group. There were no statistically significant differences between the groups in terms of complication rates or length of hospital stay. Conclusion. Conservative management is the preferred approach for blunt renal trauma with collecting system rupture. In patients who develop a urinoma, ureteral stenting or percutaneous nephrostomy should be performed.