A 28-year-old man presents to the emergency department 4 hours after a motorcycle accident. He has left flank pain and gross hematuria. CT with contrast shows a deep laceration involving the left renal collecting system with urinary extravasation (AAST Grade IV). He is hemodynamically stable. What is the most appropriate definitive management?

• A Exploratory laparotomy and nephrectomy
• B Angioembolization of the left renal artery
• C Close observation with serial hemoglobin monitoring
• D Ureteral stenting with percutaneous drainage if needed ✓

Explanation

Grade IV renal injury with urinary extravasation in a hemodynamically stable patient is managed conservatively with ureteral stenting, with percutaneous drainage of urinoma if needed. The main indication for operative management in renal trauma is hemodynamic instability, not the grade itself. Observation alone is inadequate for significant collecting system injury.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.