In this podcast, Dr. Kristin Zimmermann (DE) and Dr. Felix Campos-Juanatey (ES) discuss a grade 4 renal trauma case in a young woman who was kicked by a horse. They talk through the decision-making process for her diagnosis, treatment and follow-up, as well as the complications encounted.

Diagnostics included FAST (Focused Assessment Sonography in Trauma), and 
then the American Association of Surgery of Trauma classification (AAST) was applied for clinical decision-making and planning further management. The patient underwent a CT scan, which revealed a blunt grade 4 trauma with urinary extravasation. 

The conservative approach involved bed rest, thrombo-prophylaxis, and a long course of antibiotics due to the risk of infection, but the patient experienced a drop in haemoglobin levels. This prompted more investigations and a repeat CT scan, which revealed active bleeding. 

Subsequently, an embolisation procedure successfully stopped the bleeding. The patient recovered well, and after monitoring her condition, she was discharged with pain medication. Follow-up appointments and tests were planned to assess her long-term recovery.

Dr. Zimmermann and Dr. Campos-Juanatey are members of the EAU Guidelines panel on Urological Trauma.