Jill C Buckley1, Jack W McAninch. 1. Department of Urology, University of California School of Medicine and Urology Service, San Francisco General Hospital, USA.
Abstract
PURPOSE: We defined the mechanism and cause of pediatric renal trauma, and developed guidelines for management based on the outcome analysis of operative vs nonoperative management. MATERIALS AND METHODS: We retrospectively reviewed 374 pediatric renal injuries at San Francisco General Hospital, comparing operative vs nonoperative management based on clinical presentation, type of renal injury, hemodynamic stability, associated injuries and the results of radiographic imaging. RESULTS: Blunt trauma accounted for 89% of pediatric renal trauma with a renal exploration rate of less than 2%. Penetrating trauma represented the remaining 11% with a renal exploration rate of 76%. Of grade IV renal injuries 41% were successfully managed nonoperatively based on computerized tomography and staging in hemodynamically stable children. Our overall renal salvage rate was greater than 99%. CONCLUSIONS: Pediatric renal trauma is often minor and observation poses no significant danger to the child. In serious pediatric renal injuries early detection and staging based on clinical presentation and computerized tomography are critical for determining operative vs nonoperative management. Regardless of the type of management the standard of care is renal preservation (less than 1% nephrectomy rate in this series).
PURPOSE: We defined the mechanism and cause of pediatric renal trauma, and developed guidelines for management based on the outcome analysis of operative vs nonoperative management. MATERIALS AND METHODS: We retrospectively reviewed 374 pediatric renal injuries at San Francisco General Hospital, comparing operative vs nonoperative management based on clinical presentation, type of renal injury, hemodynamic stability, associated injuries and the results of radiographic imaging. RESULTS: Blunt trauma accounted for 89% of pediatric renal trauma with a renal exploration rate of less than 2%. Penetrating trauma represented the remaining 11% with a renal exploration rate of 76%. Of grade IV renal injuries 41% were successfully managed nonoperatively based on computerized tomography and staging in hemodynamically stable children. Our overall renal salvage rate was greater than 99%. CONCLUSIONS:Pediatric renal trauma is often minor and observation poses no significant danger to the child. In serious pediatric renal injuries early detection and staging based on clinical presentation and computerized tomography are critical for determining operative vs nonoperative management. Regardless of the type of management the standard of care is renal preservation (less than 1% nephrectomy rate in this series).
Authors: Gregory P Murphy; Thomas W Gaither; Mohannad A Awad; E Charles Osterberg; Nima Baradaran; Hillary L Copp; Benjamin N Breyer Journal: Curr Urol Rep Date: 2017-03 Impact factor: 3.092
Authors: M H Okur; S Arslan; B Aydogdu; M S Arslan; C Goya; H Zeytun; E Basuguy; I Uygun; M K Çigdem; A Önen; S Otcu Journal: Eur J Trauma Emerg Surg Date: 2016-02-01 Impact factor: 3.693