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Management of pediatric renal trauma with urinary extravasation: a retrospective study in a single clinical center
Xiaojiang Zhu1, Saisai Liu1, Yunfei Guo1
1Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China.
Insights
Pediatric grade IV renal trauma with urinary extravasation requires tailored surgical strategies. Timely intervention, including stenting or repair, leads to favorable outcomes in most children.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Radiology
Background:
- Pediatric renal trauma, particularly grade IV with urinary extravasation, has a higher surgical intervention rate compared to adults.
- The optimal timing and necessity of surgical intervention for pediatric grade IV renal trauma remain debated.
- This study focuses on therapeutic strategies for pediatric grade IV renal trauma with urinary extravasation.
Purpose of the Study:
- To investigate and analyze the therapeutic strategies for pediatric patients diagnosed with grade IV renal trauma and urinary extravasation.
- To evaluate the outcomes of various surgical and conservative management approaches.
Main Methods:
- Retrospective analysis of 19 pediatric cases (December 2016-December 2023) with grade IV renal trauma and urinary extravasation.
- Utilized plain and delayed computed tomography (CT) scans for diagnosis and assessment.
- Documented various treatment modalities including drainage, ureteral stenting, nephrostomy, and reconstructive surgery.
Main Results:
- Diverse treatments were employed: ultrasound-guided drainage (n=2), double J-tube placement (n=7), nephrostomy (n=2), pelvic repair/pyeloureteroplasty (n=6), and calyceal-ureteral anastomosis (n=2).
- Favorable outcomes were observed with urinoma drainage and ureteral stenting (9 cases).
- Reconstructive surgeries generally showed good recovery, with some cases requiring revision or managing residual hydronephrosis.
Conclusions:
- Comprehensive imaging, including delayed CT, is crucial for managing pediatric grade IV renal trauma with urinary extravasation.
- Regular follow-up with ultrasound or CT is essential for monitoring treatment effectiveness.
- Surgical intervention should be individualized based on urinary extravasation, urinoma progression, hydronephrosis, or suspected ureteropelvic junction disruption.
Background:
The majority of adult renal trauma patients choose conservative treatment, while the proportion of pediatric renal trauma patients requiring surgical intervention is higher than that of adult patients, especially grade IV renal trauma with urinary extravasation or urinoma. There has been an ongoing discussion about the need for timely surgical intervention in such pediatric patients. This study aims to investigate the therapeutic strategies of grade IV renal trauma with urinary extravasation in children.
Methods:
A retrospective analysis was conducted on the diagnosis and treatment of 19 cases of pediatric grade IV renal trauma with urinary extravasation at Children's Hospital of Nanjing Medical University from December 2016 to December 2023.
Results:
The cohort included patients with multiple injuries (n=7) and ureteropelvic junction ruptures (n=5). Initial assessment involved plain computed tomography (CT) scans for 14 patients, while 5 cases underwent delayed CT imaging to evaluate the extent of trauma. Treatment modalities included ultrasound-guided drainage of perinephric urinoma (n=2), cystoscopic double J-tube placement (n=7), nephrostomy (n=2), pelvic repair and pyeloureteroplasty (n=6), and calyceal-ureteral anastomosis (n=2). Follow-up ranged from 2 to 61 months, with an average of 15.9 months. The interventions demonstrated favorable outcomes, with complete recovery in 9 cases of urinoma drainage and ureteral stenting as evidenced by regular ultrasound monitoring. Two nephrostomy patients required revision surgery due to tube complications. Five of six cases who underwent pyeloureteroplasty recovered well, except for one who presented with moderate hydronephrosis, yet functional evaluation showed effective urinary excretion without significant obstruction. Both patients who received calyceal-ureteral anastomosis reported satisfactory healing.
Conclusions:
Effective management of pediatric grade IV renal trauma with urinary extravasation necessitates comprehensive imaging, with delayed CT scanning serving as the modality of choice when permissible. Regular follow-up via ultrasound or CT is critical for conservatively managed cases. Surgical intervention should be considered for patients with ongoing urinary extravasation, expanding urinoma, post-traumatic hydronephrosis, or suspected ureteropelvic junction disruption. The therapeutic approach, including ureteral stenting, renal laceration repair, or calyceal-ureteral anastomosis, should be tailored to the individual patient's condition.
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