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Management of grade IV renal injury in children
R S Russell1, A Gomelsky, D R McMahon
1Division of Urology and Department of Surgery, Children's Hospital Medical Center of Akron, Akron, Ohio, USA.
Insights
Grade IV blunt renal trauma in children often resolves without intervention. For symptomatic urinomas, percutaneous drainage with ureteral stenting effectively resolves urine leakage.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Nephrology
Background:
- Conservative management of pediatric renal trauma is standard.
- Urinary extravasation in blunt renal trauma presents unclear management options.
- Endoscopic techniques for renal trauma are underutilized due to small caliber concerns.
Purpose of the Study:
- To evaluate the endoscopic management of grade IV renal trauma in children.
- To assess outcomes of conservative and interventional approaches for major pediatric renal injuries.
Main Methods:
- Retrospective review of 15 children with grade IV renal trauma (1983-1996).
- Analysis of injury mechanism, associated injuries, treatment, and outcomes.
- Clinical and radiographic follow-up including blood pressure and CT scans.
Main Results:
- Nine patients with isolated injury managed by observation.
- Two of five patients with urinoma treated successfully with percutaneous drainage alone.
- Three patients with urinoma treated with cystoscopy and ureteral stenting resolved urine leakage.
- One patient developed renovascular hypertension after percutaneous drainage, requiring nephrectomy.
Conclusions:
- Grade IV blunt renal trauma in children typically resolves without intervention.
- Percutaneous drainage, with or without ureteral stenting, is effective for symptomatic pediatric urinomas.
Purpose:
Conservative nonsurgical management of major renal trauma in children is well established. However, when blunt trauma is accompanied by significant urinary extravasation, options are less than clearly defined. Endoscopic techniques, such as stents and percutaneous drainage, have not been widely used because of small caliber. We present our experience with endoscopic management of grade IV renal trauma.
Materials And Methods:
From 1983 to 1996, 15 children satisfied the criteria for grade IV renal trauma. We retrospectively reviewed the charts to assess the mechanism of injury, associated injury, treatment, hospital stay and transfusion requirement. Patients were followed clinically with blood pressure and creatinine monitoring, and by radiograph with computerized tomography.
Results:
Nine patients with isolated kidney injury were successfully treated with observation, 1 underwent early partial nephrectomy for persistent anemia and hypotension, and 5 had a urinoma, which was successfully treated with percutaneous drainage only in 2. The other 3 patients underwent cystoscopy and ureteral stent placement for high drainage output, leading to the resolution of urine leakage. In 1 patient who underwent percutaneous drainage only renovascular hypertension developed, requiring partial nephrectomy 3 months after the original injury. The remaining 13 patients had complete radiographic resolution of the injury and no evidence of hypertension.
Conclusions:
In the pediatric population grade IV blunt renal trauma usually resolves without intervention. When a symptomatic urinoma develops, percutaneous drainage, accompanied at times by ureteral stenting provides the complete resolution of persistent urine leakage.
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