PARTIAL NEPHRECTOMY IN RENAL TRAUMA WITH GRADE IV INJURY: DESCRIPTION OF A CASE AND REVIEW OF THE LITERATURE.

Abstract

Renal trauma is present in 5% of polytrauma cases, which is more frequent in young males. The management of severe renal trauma is a diagnostic and therapeutic challenge that requires the participation of multidisciplinary Urology and Radiology teams. We present the case of a 19-year-old male, with polytrauma secondary to an electric skateboard accident at a speed of 30 km/hour, with direct trauma against a bollard in the right lumbar region. In the chest-abdominal-pelvic CT, right renal lacerations are identied, the largest in the upper pole, without signs of vascular avulsion or active bleeding and retroperitoneal collection suggestive of perirenal hematoma with high-attenuation content surrounding it, compatible with urinary extravasation. Given the hemodynamic stability of the patient and the fact that there was signicant urine extravasation, a double J catheter was inserted. The CT performed at 48 hours shows hypoperfusion of the upper pole and peripheral vascular injury, compatible with several pseudoaneurysms, the largest of which was approximately 14 mm, and small peripheral anomalous vessels with arteriovenous stulas. Given the radiological ndings, selective catheterization of arteriovenous stula afferents and embolization of pseudoaneurysms with microcoils and with cyanoacrylate-lipiodol were performed. Due to the absence of vascularization of the upper renal pole and the persistence of the perirenal collection of blood and urine, it was decided to perform an open lumbar heminephrectomy of the upper pole of the right kidney. The evolution of the patient was satisfactory without hemodynamic or infection problems. One month after surgery, the double J catheter was removed. Six months after the heminephrectomy, the patient is asymptomatic with the disappearance of the perirenal collection and good morphology of the lower right hemi-kidney. Preservation of nephrons after major renal trauma in young patients is a therapeutic approach to be taken into account, despite the technical difculties that may exist.