Computerized tomography findings in pediatric renal trauma--indications for early intervention?
Publication/Presentation Date
4-1-2008
Abstract
PURPOSE: We sought to determine if initial computerized tomography findings in pediatric patients suffering blunt renal trauma with urinary extravasation were predictive of the need for operative intervention.
MATERIALS AND METHODS: A total of 17 patients with grade IV blunt renal trauma and urinary extravasation were identified between 2000 and 2007. Each computerized tomogram was reviewed to determine location, size and number of sites of extravasation, as well as the presence of contrast material in the ipsilateral ureter. These findings were compared with subsequent ureteral stent placement, percutaneous urinoma drainage, angiographic embolization and nephrectomy.
RESULTS: A total of 13 male and 4 female patients (mean age 11.1 years) were identified. Eight patients (47%) required delayed intervention. Conservative treatment was unsuccessful in patients with absence of contrast material in the ipsilateral ureter and large separation of the upper and lower poles, and in 3 of 5 patients with multiple areas of extravasation and 4 of 5 patients with transfusion requirements. The diameter (9.6 vs 9.7 mm, p = 0.96) and location of extravasation were not predictive of subsequent intervention. Two of 5 patients with posterior extravasation required intervention, both for symptomatic urinoma.
CONCLUSIONS: Early ureteral stent placement may be considered for pediatric patients with blunt renal trauma who demonstrate absence of contrast material in the ipsilateral ureter, since clinical indications for stent placement will likely develop. Further study may show if wide separation of the upper and lower poles, multiple areas of extravasation and transfusion requirement are factors in the decision for early intervention.
Volume
179
Issue
4
First Page
1529
Last Page
1532
ISSN
1527-3792
Published In/Presented At
Cannon, G. M., Jr, Polsky, E. G., Smaldone, M. C., Gaines, B. A., Schneck, F. X., Bellinger, M. F., Docimo, S. G., & Wu, H. Y. (2008). Computerized tomography findings in pediatric renal trauma--indications for early intervention?. The Journal of urology, 179(4), 1529–1533. https://doi.org/10.1016/j.juro.2007.11.094
Disciplines
Medicine and Health Sciences
PubMedID
18295268
Department(s)
Department of Surgery
Document Type
Article