Renal hematoma size may help determine need for embolization

Hematoma size as determined by computed tomography may be a readily available means of evaluating the need for angiographicembolization in patients who present with blunt renal trauma, according to a study from the University of Texas SouthwesternMedical Center in Dallas. The evaluation may also apply to penetrating injuries.

"The size of the hematoma is a new way of looking at these injuries," lead author Allen Morey, MD, told Urology Times. "Traditional staging calls for evaluating renal injuries in terms of the depth of the injury and the involvement of thecollecting system. This is the first time that anyone has tried to assess the magnitude of perirenal involvement."

Dr. Morey and his colleagues took advantage of the increased use of computed tomography in evaluating trauma patients toreview the scans of 194 patients in the Parkland Memorial Hosptial renal trauma database. Thirty-six patients met the criteriafor study (grade III or IV renal laceration with perirenal hematoma on preoperative CT scan).

Researchers found that patients who required embolization had a significantly larger average hematoma size than did those withrenal injuries who did not warrant intervention. The hematoma area of those requiring intervention was 103.5 cm² compared to65.7 cm² for those who did not.

"I don't think it was a great surprise to us that angioembolization was correlated with hematoma size," Dr. Morey said at theAUA annual meeting yesterday. "What may have been unexpected was that transfusions were not associated with the procedure, norwere nephrectomies.

"By using this [CT] technology, we can preserve kidneys in many of these complex lacerations, which are very challenging in thebest of circumstances. In trauma scenarios, optimal conditions are lacking. This may provide information that will allownephron-sparing management."