Observation vs. early drainage for grade IV blunt renal trauma: a multicenter study
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ORIGINAL ARTICLE
Observation vs. early drainage for grade IV blunt renal trauma: a multicenter study Ala Chebbi1,18 · Benoit Peyronnet2 · Anthony Giwerc1 · Lucas Freton2 · Marine Hutin3 · Jonathan Olivier4 · Quentin Langouet5 · Marina Ruggiero6 · Ines Dominique7 · Clémentine Millet8 · Sébastien Bergerat9 · Paul Panayatopoulos10 · Reem Betari11 · Xavier Matillon7 · Thomas Caes4 · Pierre‑Marie Patard12 · Nicolas Szabla13 · Nicolas Brichart14 · Axelle Boehm5 · Laura Sabourin8 · Kerem Guleryuz13 · Charles Dariane15 · Cédric Lebacle6 · Jérome Rizk4 · Alexandre Gryn12 · François‑Xavier Madec16 · Xavier Rod16 · Gaelle Fiard17 · Benjamin Pradere5 · Christian Pfister1 · François‑Xavier Nouhaud1 · for the TRAUMAFUF collaborative group Received: 22 March 2020 / Accepted: 11 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The aim of this study was to compare observation and early drainage by ureteral stenting in patients with blunt renal trauma and urinary extravasation. Materials and methods A retrospective national multicenter study was performed including all patients admitted for renal trauma at 17 hospitals between 2005 and 2015. Patients presenting with a urinary extravasation on initial imaging were considered for inclusion. Patients were divided in two groups according to the initial approach: observation vs. early drainage by ureteral stent (within 48 h after admission). The primary endpoint was the persistence of urinary extravasation on follow-up imaging. Results Out of 1799 patients with renal trauma, 238 were included in the analysis (57 in the early drainage and 181 in the observation group). In the early drainage group, 29 patients had persistent urinary extravasation vs. 77 in the observation group (50.9% vs. 42.5%; p value = 0.27). The rates of secondary upper urinary tract drainage did not differ significantly between the early drainage group (26.4%) and the observation group (16%) (p = 0.14). There were no statistically significant differences between the two groups in terms of secondary nephrectomy (0% vs. 2.8%; p = 0.34), and death from trauma (0% vs. 1.8%; p = 0.99). In multivariate analysis, early drainage remained not statistically associated with persistence of urinary extravasation on follow-up imaging (OR = 1.35; p = 0.36) Conclusion In this multicenter cohort, observation was not different from early drainage in terms of persistent urinary extravasation after grade IV blunt renal trauma. Further randomized controlled prospective trials are needed to confirm these findings. Keywords Blunt renal trauma · Urinary extravasation · Observation · Early drainage · Ureteral stenting * Ala Chebbi [email protected]
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Urology, University of Angers, Angers, France
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Urology, University of Amiens, Amiens, France
Urology, University of Strasbourg, Strasbourg, France
Urology, University of Rouen, Rouen, France
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Urology, University of Rennes, Rennes, France
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Urology, University of Toulouse, Toulouse, France
Urology, University o
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