Michael Coburn, MD, FACS, presented “Management of Renal Trauma – An Evidence-Based Approach” at the 26th Annual Innovations in Urologic Practice on September 15th, 2022.
How to cite: Coburn, Michael. “Management of Renal Trauma – An Evidence-Based Approach” September 2022. Accessed May 2024. https://grandroundsinurology.com/management-of-renal-trauma-an-evidence-based-approach/
Management of Renal Trauma – An Evidence-Based Approach – Summary
Michael Coburn, MD, FACS, Professor and the Russell and Mary Hugh Scott Chair of the Department of Urology at Baylor University, discusses the management of renal trauma, and compares the indications for interventional treatment versus active observation. Dr. Coburn first examines the decision of whether to explore the injured kidney, considering hemodynamic stability and the extent of staging. He highlights the American Association for the Surgery of Trauma (AAST) organ injury scaling system, emphasizing intervention in the grade IV and grade V injuries. Dr. Coburn explores the traditional indicators of exploration; both absolute and relative. With this framework, he shares examples of renal trauma, highlighting when operative approaches are indicated. Dr. Coburn reviews the operative management of renal injuries. He explores the indications for exploration, where staging will greatly inform management. He explains the conditions in which postoperative CT staging is possible. Dr. Coburn next discusses surgical exploration, where pedicle access and renal exposure are considered. He explores when a nephrectomy should be weighed against measures including hemostasis and drainage. Dr. Coburn next considers indications for nephrectomy, presents potential damage control strategies, and considers factors including the status of contralateral kidney. Dr. Coburn reviews the advantages of vascular control prior to renal exploration, emphasizing maintaining the ability to access the renal pedicle prior to operation on the hematoma, and presents a technique to rapidly access the pedicle. Dr. Coburn discusses the standard renal exposure and mobilization approach once pedicle access is obtained, as well as drainage and postoperative management. Dr. Coburn concludes by discussing the role of interventional radiology (IR) and endourologic intervention in renal trauma.
About The 26th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma; men’s health topics like male infertility, andrology, and sexual dysfunction; OAB and voiding dysfunctions; and ways to diagnose and treat infections in the urology patient.
For further educational activities from this conference, visit our collection page.
