Computerized Tomography Findings In Pediatric Renal Trauma - Indications For Early Intervention?

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 18 Jul 2008 - 1:00 PDT

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UroToday.com - The study out of Children's Hospital of Pittsburgh evaluated CT scans for blunt renal trauma to see if they correlated with the need for operative intervention when urinary extravasation was present.

A total of 17 patients with grade IV blunt renal trauma and urinary extravasation were identified between 2000 and 2007. Each CT scan 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 were then compared to the findings at the time of surgery - whether surgey included stent placement, percutaneous urinoma drainage, angiographic embolization and nephrectomy.

The mean age of the 17 patient group (13 males and 4 females) was 11.1 years.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. The group also found that conservative treatment was unsuccessful in patients with multiple areas of extravasation, as well as a majority of patients who required transfusions. The diameter and the location of the extravasation alone were not predictive of subsequent intervention. Almost half of the patients with a posterior extravasation required intervention for symptomatic uronoma.

The group concluded that early ureteral stent placement might be a consideration for children with blunt renal trauma if they demonstrate an absence of contrast material in the ipsilateral ureter. Also if there are multiple areas of extravasation, or the patients do require transfusions, decisions with respect to intervention should be made early.

Cannon GM Jr, Polsky EG, Smaldone MC, Gaines BA, Schneck FX, Bellinger MF, Docimo SG, Wu HY
J Urol. 2008 Apr;179(4):1529-33.

Written by UroToday.com Medical Editor Pasquale Casale, MD

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