UROGENITAL TRAUMA

Evaluation and management of renal injuries: consensus statement of the renal
trauma subcommittee.
Santucci RA, Wessells H, Bartsch G, Descotes J, Heyns CF, McAninch JW, Nash P,
Schmidlin F
BJU Int. 2004; 93: 937-54

• Objective: To determine the optimal evaluation and management of renal injuries by review of the world’s English-language literature on the subject.
• Methods: A consensus conference convened by the World Health Organization and the Societe Internationale d’Urologie met to critically review reports of the diagnosis and treatment of renal trauma. The English-language literature about renal trauma was identified using Medline, and additional cited works not detected in the initial search obtained. Evidence-based recommendations for the diagnosis and management of renal trauma were made with reference to a five-point scale.
• Results: There were many Level 3 and 4 citations, few Level 2, and one Level 1 which supported clinical practice patterns. Findings of nearly 200 reviewed citations are summarized.
• Conclusions: Published reports on renal trauma still rely heavily on expert opinion and single-institution retrospective case series. Prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates the behaviour of practitioners.
  
  
• Editorial Comment
  Consensus conferences, using the so called “Cochrane Review Method” are becoming increasingly common, and may be useful to summarize intricate data sets such as how to mange complex genitourinary trauma. The technique is robust for several reasons. First, an attempt to read “every” published paper on the subject is made. Secondly, the manuscripts are carefully graded by “level of evidence” (Level 1=randomized trials; 2=prospective studies; 3=retrospective studies, 4=case series/case reports, 5=expert opinion). Third, consensus conference members are chosen with proven expertise in the field, all in order to maximize the value of the review. This particular review was sponsored by the World Health Organization (WHO) and was undertaken by the Societé Internationale d’Urologie (SIU), and represents thousands of hours of work.
  In this review, over 1400 articles on the subject of renal injury were identified, although only 182 were ultimately cited in this review. Although the findings of this 14,000 word review are too numerous to discuss in detail here, I encourage readers who wish to understand the most modern and up to date treatment of renal injuries to obtain and read it. Interestingly, there were only a few prospective studies and only 1 randomized trial in existence across the whole trauma series. Clearly, the future of research in the field of genitourinary trauma will be best served by conducting prospective and perhaps even randomized studies into those questions most urgently requiring answers.

Dr. Richard A. Santucci
Assistant Professor of Urology
Wayne State University
Detroit, Michigan, USA