[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.


CONCLUSIONS
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.
Department of Pediatric Surgery, Behçet Uz Children Hospital, İzmir-Turkey. abasakucan@yahoo.com.
Ayşe
A
Başak Uçan
Department of Pediatric Surgery, Behçet Uz Children Hospital, İzmir-Turkey.
Zehra
Z
Günyüz Temir
Department of Pediatric Surgery, Behçet Uz Children Hospital, İzmir-Turkey.
Arzu
A
Şencan
Department of Pediatric Surgery, Behçet Uz Children Hospital, İzmir-Turkey.
Aytaç
A
Karkıner
Department of Pediatric Surgery, Behçet Uz Children Hospital, İzmir-Turkey.
Hüseyin
H
Evciler
D000007:Abdominal Injuries / Q000601:surgery*; D058186:Acute Kidney Injury / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D000072700:Conservative Treatment; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014421:Turkey; D014949:Wounds, Nonpenetrating / Q000601:surgery*