Management of grade IV renal injury in children

Title

Management of grade IV renal injury in children

Creator

Russell R S; Gomelsky A; McMahon D R; Andrews D; Nasrallah P F

Publisher

Journal of Urology

Date

2001
2001-09

Description

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.

Subject

endoscopy; kidney; lacerations; nonpenetrating; trauma; Urology & Nephrology; wounds

Format

Journal Article

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Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

1049-1050

Issue

3

Volume

166

Citation

Russell R S; Gomelsky A; McMahon D R; Andrews D; Nasrallah P F, “Management of grade IV renal injury in children,” NEOMED Bibliography Database, accessed May 22, 2022, https://neomed.omeka.net/items/show/6977.

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