Stab wounds associated with hematuria: A review of 67 cases
The clinical records of 67 patients who underwent surgical exploration for stab wounds associated with hematuria were reviewed in an attempt to evaluate the need for mandatory operation and to define criteria for possible nonoperative management of such cases. Minor renal injuries without associated intra-abdominal lacerations were found in 61% of the patients. Delayed renal hemorrhage occurred in 15% of the patients despite early exploration, suture and drainage of the kidney, and antibiotic prophylaxis. Of 7 nephrectomies 5 were performed for secondary hemorrhage. Postoperative pulmonary complications arose in 28% of the patients. A policy of mandatory operation on all patients with stab wounds and hematuria led to apparently needless surgery in 61% of the patients in this series. Retrospective analysis revealed that the rate of probably unnecessary operations could have been reduced to 24% by selecting for operation only those patients with signs of severe hemorrhage, associated intra-abdominal injury or major extravasation of contrast material on excretory urography.