Comparison of Operative Versus Conservative Management in Pediatric Renal Trauma

Joung, Jae Young; Park, Sung Chan; Kim, Jin Bum; Kim, Han Kwon; Park, Jong Yeon; Cheon, Sang Hyun; Moon, Kyung Hyun; Kim, Kun Suk

Abstract

PURPOSE: Despite the increasing incidence of renal trauma, the management of renal injuries still remains controversial. Because the renal anatomy of children is different to that of adults, the management of their renal injuries will differ. We attempted to clarify the efficacy of conservative management for pediatric renal trauma by comparing our experiences of conservative and operative managements.
MATERIALS AND METHODS
The medical records of 46 patients, with blunt renal injuries, were retrospectively reviewed. All patients were evaluated by computed tomographic scanning. Injuries were graded according to the American Association for the Surgery of Trauma Organ Injury Scale.
RESULTS
37 patients were initially managed conservatively and 9 by an early operation. 35 of the 37 patients (94.6%) were successfully managed conservatively, but the other 2 required a delayed operation (1 renorrhaphy, 1 open clot drainage), but a delayed nephrectomy was not required. Two of the 3 patients with urine leakage spontaneously resolved, and the other was resolved with endoscopic ureteral stenting. 7 of the 9 patients having undergone an early operation resulted in a nephrectomy, but kidney preservation was only possible in 2.
CONCLUSIONS
Except for the hemodynamically unstable patients and those with a pedicle injury, conservative management was effective from the view point of renal preservation. Major renal lacerations and most of the urine leakages resolved spontaneously. Persistent extravasation can be managed with minimally invasive treatment, such as ureteral stenting. We consider the conservative management of renal injuries, even with abdominal exploration, for the treatment of associated organ injuries.