Contemporary management of renal trauma: differences between urologists and trauma surgeons.

Abstract

The purpose of this study was to evaluate the contemporary practice patterns of urologists (UR) and trauma surgeons (TS) regarding controversial topics in the management of renal trauma (RT). We conducted a national survey of all Society of Genitourinary Reconstructive Surgeons members and a random sampling of American Association for the Surgery of Trauma members between October and November 2010 via email, regarding management routines for various stages of blunt and penetrating RT. Response rate was 33%. In all, 21% of TS and 3% of UR (p = 0.005) do not use any tests to confirm the presence of another kidney before exploring an expanding retroperitoneal hematoma, despite lack of preoperative imaging. To confirm the presence of another kidney, UR prefer the "one-shot" intravenous pyelogram (82%), whereas TS prefer palpation (61%; p < 0.001). TS do not obtain primary renal vascular control before opening the retroperitoneal, whereas UR do (21% vs. 71%; p < 0.001). TS utilize early angiography for the control of intravascular contrast extravasation more commonly than UR (88% vs. 55%; p < 0.001). TS overutilize ureteral stenting (50% vs. 24%; p < 0.001) for isolated collecting system injuries compared with UR. Differences in practice patterns between TS and UR tend to follow differences in published guidelines. There is an apparent lack of communication and differing treatment methods for RT. That there are two camps with differing "community standards of practice" indicates that there is a desperate need for reeducation and for large-scale, multi-institutional prospective studies on RT to "standardize" management.