Maximizing Renal Function: Delayed Robotic Reconstruction of a Partially Devascularized Kidney Following High Grade Ureteral and Renal Trauma

Blunt or penetrating abdominal trauma often involves the kidneys. Current guidelines recommend non-operative management in hemodynamically stable patients with high-grade renal trauma. We present the case of a 25-year-old female patient status post motor vehicle collision presenting with a grade 4 right renal laceration on contrast CT involving complete avulsion of the ureteropelvic junction and devascularization of the lower pole successfully managed through delayed surgical reconstruction. Our approach involves placement of a percutaneous nephrostomy tube into the viable superior pole and subsequent ureteral rest while awaiting resolution of the urinoma prior to operative management. Following high grade renal trauma with partial devascularization, reconstructive surgery may be considered in a delayed manner, in young and otherwise healthy patients in an attempt to preserve functional nephron mass. Preoperative drainage of the remaining viable kidney, adequate ureteral rest, and meticulous hilar dissection are valuable in ensuring surgical success.