Renal rupture after the Credé maneuver

Area of Science:

• Pediatric Nephrology
• Urology
• Neurogenic Bladder Management

Background:

• Neurogenic bladder and detrusor sphincter dyssynergia are common in children with spinal cord conditions.
• The Credé maneuver is a technique sometimes used to empty the bladder in these patients.
• Vesicoureteral reflux is a known complication, but renal rupture is less common.

Observation:

• A case is presented of a young girl with neurogenic bladder and detrusor sphincter dyssynergia.
• The patient developed renal rupture and a large perinephric urinoma after undergoing the Credé maneuver.
• Deterioration of renal function was observed following the maneuver.

Findings:

• Percutaneous drainage of the urinoma led to initial improvement.
• Transitioning management to clean intermittent catheterization resulted in the return of normal renal function.
• The Credé maneuver was implicated as the cause of renal injury in this case.

Implications:

• The Credé maneuver should be avoided in children with neurogenic bladder and a nondenervated urethral sphincter.
• Clean intermittent catheterization is a recommended alternative for bladder management in this population.
• This case highlights the potential risks of the Credé maneuver and emphasizes the importance of appropriate bladder management strategies.