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High-grade renal injuries in children—is conservative management possible?
- Source :
- Urology. 64:574-579
- Publication Year :
- 2004
- Publisher :
- Elsevier BV, 2004.
-
Abstract
- Objectives To review our experience with the management of high-grade (grade IV and V) renal injuries to clarify the role of conservative management. Methods From 1991 to 2003, 79 consecutive patients (age range 2 to 14 years) with renal injuries were treated in an urban level I pediatric trauma center. Twenty children were identified as having high-grade renal injury (grade IV, 10 children and grade V, 10 children). The mechanism of injury was blunt trauma in 17 patients (85%) and penetrating trauma in 3 (15%). Results Of the 10 patients with grade IV injury, 8 (80%) were successfully treated conservatively with bedrest and catheter drainage. Two patients with persistent urine leaks required ureteral stenting, and one subsequently required open operative repair. The initial radiographic findings in both patients demonstrated complete renal fracture with retained vasculature to both renal segments. All 10 patients with grade V injury required open operative management and only 3 (30%) achieved long-term renal salvage. Conclusions Most children with grade IV renal injury can be treated conservatively. Patients with complete renal fracture or significant urinary extravasation on initial radiographic imaging may be less likely to undergo spontaneous resolution. Patients with a persistent urinary leak can be successfully treated with internal drainage. Grade V injuries are associated with an increased risk of requiring open operative intervention, and the renal preservation rates are low.
- Subjects :
- Male
Nephrology
medicine.medical_specialty
Adolescent
Urology
Urinary system
Hemorrhage
Wounds, Penetrating
Kidney
Wounds, Nonpenetrating
Nephrectomy
Severity of Illness Index
Renal segment
Trauma Centers
Internal medicine
medicine
Humans
Blood Transfusion
Child
Retrospective Studies
Multiple Trauma
business.industry
Endoscopy
Retrospective cohort study
Length of Stay
medicine.disease
Surgery
Treatment Outcome
medicine.anatomical_structure
Blunt trauma
Child, Preschool
Drainage
Female
Laparoscopy
Stents
Tomography, X-Ray Computed
Urinary Catheterization
business
Bed Rest
Penetrating trauma
Pediatric trauma
Subjects
Details
- ISSN :
- 00904295
- Volume :
- 64
- Database :
- OpenAIRE
- Journal :
- Urology
- Accession number :
- edsair.doi.dedup.....97ec3188a141d4d3d479949cb206e96f
- Full Text :
- https://doi.org/10.1016/j.urology.2004.04.069