Kidney-preserving surgery for AAST grade IV penetrating renal trauma with ureteropelvic disruption: a military case report at Role 3

High-grade renal trauma (AAST IV and V) represents a significant challenge for surgeon in both civilian and military settings. Renal pelvic disruption with complete ureteral transection is uncommon and technically challenging for kidney repair, although an organ-preserving approach is possible in such cases to preserve renal function. Aim. The aim of this report is to present a case of successful kidney-preserving surgical treatment of severe penetrating renal trauma (AAST IV) with ureteropelvic junction disruption in a combat environment. We highlight the feasibility of reconstructive surgery at Role 3 facilities and emphasize its value in organ preservation and long-term rehabilitation of military personnel. Materials and methods. We report the case of a military service member who was admitted with stable hemodynamic parameters but developed, within three hours, a decline in hemoglobin concentration from 13.0 g/dL to 8.9 g/dL accompanied by hemodynamic instability. An exploratory laparotomy was performed to achieve hemostasis, surgical revision, and an organ-preserving intervention. Results. The patient underwent resection of the lower pole of the right kidney with ligation of the inferior segmental vessels. Ureteral continuity was restored by end-to-end anastomosis with stenting. Postoperatively, the patient was stabilized, and renal function was preserved. Conclusions. This case illustrates the feasibility of an organ-preserving strategy in severe renal trauma (AAST IV) with ureteropelvic junction injury under combat conditions. Reconstructive procedures performed at Role 3 facilities enable kidney preservation and maintenance of urinary tract function, which is of particular importance for the long-term rehabilitation of military personnel.