100 PREDICTIVE VALUES FOR NEPHRECTOMY AGAINST BLUNT RENAL TRAUMA: SINGLE INSTITUTE ANALYSIS OF 182 JAPANESE PATIENTS

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 2012100 PREDICTIVE VALUES FOR NEPHRECTOMY AGAINST BLUNT RENAL TRAUMA: SINGLE INSTITUTE ANALYSIS OF 182 JAPANESE PATIENTS Satoshi Yazawa, Yosuke Nakajima, Kent Kanao, Rei Ohara, Mitsuhide Kitano, Hiroshi Yoshii, and Mototsugu Oya Satoshi YazawaSatoshi Yazawa Kanagawa, Japan More articles by this author , Yosuke NakajimaYosuke Nakajima Kanagawa, Japan More articles by this author , Kent KanaoKent Kanao Kanagawa, Japan More articles by this author , Rei OharaRei Ohara Kanagawa, Japan More articles by this author , Mitsuhide KitanoMitsuhide Kitano Kanagawa, Japan More articles by this author , Hiroshi YoshiiHiroshi Yoshii Kanagawa, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.147AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of the present study was to evaluate predictive factors for nephrectomy to treat blunt renal trauma and the clinical usefulness of the grading scales for trauma proposed by the American Association for the Surgery of Trauma (AAST) and Japanese Association for the Surgery of Trauma (JAST). METHODS This is a Japanese single institute analysis and a retrospective review of blunt renal traumas treated at our hospital over a 28 year period. We included patients who were diagnosed with renal trauma by CT scan or surgical exploration within 24 hours of the injury. These patients had a mean age of 30.9 ± 17.1 (4-85) years, and there were 151 males and 31 females. Seventy-nine patients had an injured right kidney and 102 patients an injured left kidney. One patient was injured bilaterally. All patients were classified according to the AAST and JAST grading scales. RESULTS The medical records of 182 blunt renal trauma patients from 1982 to 2010 were investigated. Thirty six patients (19.8%) had undergone immediate surgical exploration. Conservative therapy was performed in 141 patients (77.5%), including transcatheter arterial embolization (n = 7), percutaneous drainage (n = 4), and ureteral stent (n = 2). Surgical therapy was performed in 41 patients (22.5%), including repair (n = 2), partial nephrectomy (n = 13), and total nephrectomy (n = 26). The nephrectomy rate was 14.3%. Multiple logistic regression analysis confirmed that both the JAST grading scale (p = 0.003) and serum creatinine level (p = 0.043) were useful predictors for nephrectomy. By utilizing the serum creatinine level to predict nephrectomy cases on their first visit, the degree of sensitivity was 78.3% when the cut-off point was 1.0 mg/dL, and the specificity was 95.1% when the cut-off point was 1.5 mg/dL. The AAST grading scale (p < 0.001) and JAST grading scale (p < 0.001) had a statistically significant correlation with the immediate surgical exploration rate and nephrectomy rate, respectively. CONCLUSIONS Although this study provided preliminary evidence that both the AAST and JAST grading scales could be powerful and useful parameters for predicting clinical outcome and for decision- making in terms of therapeutic strategy in blunt renal trauma, future large multicenter studies are needed to confirm their effectiveness. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e40-e41 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Satoshi Yazawa Kanagawa, Japan More articles by this author Yosuke Nakajima Kanagawa, Japan More articles by this author Kent Kanao Kanagawa, Japan More articles by this author Rei Ohara Kanagawa, Japan More articles by this author Mitsuhide Kitano Kanagawa, Japan More articles by this author Hiroshi Yoshii Kanagawa, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...