The nonoperative approach to major blunt renal trauma.

The treatment of major blunt renal trauma remains controversial, with opinion divided between those who favor expectant management and those who favor surgical exploration. The goals of each treatment regimen are to assure patient safety while simultaneously preserving renal function. It is our policy at Case Western Reserve, MetroHealth Medical Center (Cleveland, OH) that all hemodynamically stable patients be initially treated by observation. Renal exploration is reserved for those patients who become unstable or who develop complications. In this review, we compare our results with those in the literature in an attempt to determine whether a selective nonoperative approach to major renal trauma fulfils the goals of patient safety and renal preservation.