Diagnosis and treatment of traumatic pelvi-ureteric junction disruption in children

Abstract

Objective To improve the diagnosis and treatment of traumatic pelvi-ureteric junction(PUJ)disruption in children. Methods A retrospective study was conducted for a total of 31 patients with traumatic PUJ disruption from 1993 to 2014. Their clinical records were reviewed for mechanism of injury, diagnostics and treatment. Results There were 23 males and 8 females with a mean age of 6.25(1.5-10.5) years. The lesions were right(n=18) and left(n=5). And the causes were traffic accident(n=30) and penetrating injury(n=1). For 5 cases of initially presenting at our hospital, the mean interval from trauma to diagnosis was 12.5(5-20) days. For the remainder transferred to our hospital beyond 24 h, the mean interval from trauma to diagnosis was 42(20-90) days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed for 21 and 5 patients respectively. And ileal and appendix replacement for ureteral injuries were finally performed for 2 and 1 patient respectively. Two patients underwent nephrectomy. Hydronephrosis of injured kidney lessened and function improved in 25 patients. Conclusions PUJ disruptions are uncommon and more likely to have a delayed diagnosis because of associated injuries. Haematuria is not indicative of ureteral trauma in children. Computed tomography(CT) with delayed excretory phase imaging may aid its diagnosis. And a definite diagnosis is made by retrograde pyelography under anesthesia. Definitive ureteral reconstruction is preferred with pelvi-ureteric reanastomosis or nephrostomy. Drainage of circumrenal urinoma and nephrectomy should be avoided. Key words: Injury of ureter; External injury; Treatment