Renal Trauma Management: A Century of Evolution From "Stabbing in the Dark" to the Radiographic Revolution.

Abstract

Objective: To outline how practices have shifted over the past 100years while highlighting some of the key figures who have influenced the field. The management of renal trauma has long been an evolving and at times controversial field of study within urology. Though surgical exploration and nephrectomy were more common in the past, practice has shifted to observation and avoidance of intervention in most cases. Over the past century, technological advancements have given urologists and trauma surgeons the tools to improve clinical outcomes, which we outline in the following essay.

Methods: A broad literature review was performed of archival material and medical journal articles that included both primary and secondary documents related to renal trauma management and advances in relevant technology. Primary subject interviews were conducted with subject matter experts including Dr Jack McAninch and Dr Jeremy B. Myers.

Results: The earliest days of renal trauma were marked by conservatism that was largely a consequence of the few options available for evaluation and worthwhile intervention. As surgical techniques developed and the role of exploratory laparotomy became established, there was considerable debate over how aggressive surgical management should be. Alongside these operative advances, the evolution of radiographic techniques became one of the most impactful aspects in renal trauma management, culminating with the introduction of CT and subsequent grading scales.

Conclusion: Over the past century, urologists have progressed from stabbing in the dark without imaging or clinical consensus, to managing renal trauma with high quality imaging and evidence-based guidelines.