MP18-17 ARE ALL PEDIATRIC GRADE 4 RENAL TRAUMAS THE SAME?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma I1 Apr 2015MP18-17 ARE ALL PEDIATRIC GRADE 4 RENAL TRAUMAS THE SAME? Christopher Long, Sasha Tharakan, Dana Weiss, David Chu, Aseem Shukla, Michael Nance, and Arun Srinivasan Christopher LongChristopher Long More articles by this author , Sasha TharakanSasha Tharakan More articles by this author , Dana WeissDana Weiss More articles by this author , David ChuDavid Chu More articles by this author , Aseem ShuklaAseem Shukla More articles by this author , Michael NanceMichael Nance More articles by this author , and Arun SrinivasanArun Srinivasan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1049AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Grade 4 renal trauma can be further subdivided to specify vascular or collecting system injury. While many injuries may be observed, surgical intervention may be warranted and these include endoscopic and reconstructive surgical procedures. We reviewed our experience with pediatric renal trauma to see if the clinical course and management of patients with grade 4 vascular injury are similar to patients with collecting system injury. METHODS We identified all children (<19 years) treated for blunt renal trauma in the period of January 2003-December 2013. Charts were abstracted for demographic data, radiographic appearance, management and outcome. We grouped patients as Grade 4a if they had vascular injury with no evidence of collecting system injury and Grade 4b if they had collecting system injury regardless of vascular injury. Statistical analysis was done with SPSS. RESULTS A total of 27 patients were found to have a Grade 4 renal injury during the inclusion period, of which 10/27 (37%) were vascular and 17/27 (63%) were collecting system injuries. The population had a mean age of 11.8 years and 20/27 (74%) were male. Mean length of stay was 9.4 days for vascular injury and 8.2 for collecting system injury. A total of 13 interventions were required (Table 1). One patient in the vascular injury group required intervention, a renal embolization and open suprapubic tube placement. The remaining 12 were in the collecting system injury group, 11 of whom underwent double J stent insertion and 1 who underwent percutaneous drain insertion. Comparing the two groups by non-parametric analysis with Mann Whitney U test showed a significantly higher intervention rate in Grade 4 collecting system injury. CONCLUSIONS Post trauma management was significantly different between the two groups. We propose that Grade 4 renal injuries in children should be separated into Grade 4a for vascular and Grade 4b for collecting system injury to help guide management decisions. Grade 4a Injury (isolated vascular injury) N=10 (37%) Grade 4b (Collecting system injury) N=17 (63%) P value Hospital length of stay (mean, days) 9.4 8.2 non-significant (ns) Intervention (%) 10% 63% 0.002 Fever 2 4 ns Ileus 0 3 ns Persistent gross hematuria, flank pain 1 2 ns Readmission 0 2 ns © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e212-e213 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Long More articles by this author Sasha Tharakan More articles by this author Dana Weiss More articles by this author David Chu More articles by this author Aseem Shukla More articles by this author Michael Nance More articles by this author Arun Srinivasan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...