Minimally invasive theurapeutic approaches in pediatric nonvascular fourth-grade renal trauma]

BACKGROUND: Conservative management procedures are implemented in cases of low-grade pediatric blunt renal trauma, but procedures for grade 4 injuries are not clearly defined. The present objective was to discuss treatment procedures in patients who presented with or developed urinoma during follow-up. METHODS: Treatment procedures implemented in 8 patients (female: male ratio=1:7; average age: 6) with grade 4 renal trauma who presented to the clinic between 2003 and 2012 were retrospectively analyzed. RESULTS: Cause of renal injury was fall in 4 cases, blunt abdominal trauma in 3 cases, and being trapped in a harvesting machine in 1 case. Right renal trauma was diagnosed in 4 cases, left renal trauma in 4. Emergent exploration due to hemodynamic instability was not necessary. Although urinary extravasation was observed upon investigation in 1 patient, urinoma did not form during follow-up. Five of the 7 patients with urinoma were treated with drainage procedures (double-J catheter (JJ) in 3, percutaneous drainage (PD) in 1, followed by JJ catheter placement). In spite of initial PD, inferior pole nephrectomy and pyeloplasty were performed in the remaining 2 cases due to decomposition of the integrity of the urinary system. In 1 patient, pyeloplasty was performed following regression of symptoms due to ureteropelvic obstruction. Catheters were removed when extravasation was not detected in the urinary system. Average time of removal was 4 months for JJ catheters and 1.5 months for PD catheters. DISCUSSION: Pediatric grade 4 renal trauma can be successfully treated with minimally invasive procedures. Initial implementation of these procedures increases the chance of kidney salvage, even when surgical intervention is eventually performed.