[Injuries of the renal pedicle: is renal revascularization justified?].

Objective: Renal trauma with pedicle lesions may require emergency vascular repair, a surveillance in a surgical unit or immediate or secondary nephrectomy. The objective of this study was to evaluate these various treatment modalities.

Material And Methods: 28 patients presenting with renal pedicle trauma, treated in two urological centres between 1985 and 1995 were reviewed. All cases of trauma were investigated by intravenous urography, CT and/or arteriography. 16 patients had associated intra-abdominal lesions.

Results: 7 patients underwent vascular repair after a mean interval of 4.8 hours. There were 5 nephrectomies and 2 functional kidneys, including 1 with hypertension. 13 patients underwent first-line nephrectomy: 4 performed as an emergency for haemodynamic instability, and 9 performed as a deferred emergency for silent kidney or secondary haemodynamic disorders. The mean time to diagnosis was 20 hours. No complication was observed in this group. Non-surgical management was decided in 8 patients. The mean time to diagnosis was 7.5 hours. One death was observed in this group, due to associated cerebral lesions. 3 patients subsequently underwent late nephrectomy for severe hypertension and 4 had a persistent silent kidney without sequelae. Overall: 21 nephrectomies, 2 functional kidneys (1 patient was hypertensive), 4 silent kidneys without hypertension and one death were observed.

Conclusion: In cases of renal pedicle trauma seen after the 4th hour, the severity of ischaemic lesions and renal sequelae and the small number of kidneys saved despite revascularization surgery argue in favour of immediately elective nephrectomy.