Management of blunt renal trauma: an experience in 84 children

The study aimed to investigate the method of management and diagnosis of pediatric blunt renal trauma, and determine whether all grades of hemodynamically stable injuries can be managed conservatively. Eighty-four children, presented with blunt renal trauma and treated in the urinary surgery department of Children's Hospital of Chongqing Medical University, were reviewed. Data collected from the medical records of the identified patients included: (1) demographics, (2) management, (3) severity of hematuria, (4) findings on computed tomography, (5) associated injuries, (6) duration of hospital stay, and (7) follow-up complications. Of the 84 patients, only 11 (13%) required operations. Five (6%) patients were immediately operated for vascular instability; one (1.2%) patient had delayed operation for missed Ureteropelvic Junction (UPJ) disruption, one (1.2%) patient for abscess, and four (4.7%) patients for persistent bleeding. All the children with low-grade injuries and part of them with high-grade injuries were selected for nonoperative management of real injuries. The diagnosis rate of blunt renal trauma using Ultrasonography (US) was 91%. The rate of diagnosis by intravenous pyelography (IVP) was 82% and that by computed tomographic (CT) was 100%. However, Ultrasonography could not diagnose all patients with grade I injuries. Only 3 (8%) of 36 children had hypertension managed conservative by followed-up for 4 months. The goals of treatment of blunt renal injuries include minimizing accrued staging and complications. Our study supported that conservative management is the first choice for all grades of hemodynamically stable children with blunt renal trauma. Abdominal CT scanning is the most accurate screening test for high-grade injuries and older children.