Management of pediatric renal trauma with urinary extravasation: a retrospective study in a single clinical center.

Background: The majority of adult renal trauma patients choose conservative treatment, while the proportion of pediatric renal trauma patients requiring surgical intervention is higher than that of adult patients, especially grade IV renal trauma with urinary extravasation or urinoma. There has been an ongoing discussion about the need for timely surgical intervention in such pediatric patients. This study aims to investigate the therapeutic strategies of grade IV renal trauma with urinary extravasation in children.

Methods: A retrospective analysis was conducted on the diagnosis and treatment of 19 cases of pediatric grade IV renal trauma with urinary extravasation at Children's Hospital of Nanjing Medical University from December 2016 to December 2023.

Results: The cohort included patients with multiple injuries (n=7) and ureteropelvic junction ruptures (n=5). Initial assessment involved plain computed tomography (CT) scans for 14 patients, while 5 cases underwent delayed CT imaging to evaluate the extent of trauma. Treatment modalities included ultrasound-guided drainage of perinephric urinoma (n=2), cystoscopic double J-tube placement (n=7), nephrostomy (n=2), pelvic repair and pyeloureteroplasty (n=6), and calyceal-ureteral anastomosis (n=2). Follow-up ranged from 2 to 61 months, with an average of 15.9 months. The interventions demonstrated favorable outcomes, with complete recovery in 9 cases of urinoma drainage and ureteral stenting as evidenced by regular ultrasound monitoring. Two nephrostomy patients required revision surgery due to tube complications. Five of six cases who underwent pyeloureteroplasty recovered well, except for one who presented with moderate hydronephrosis, yet functional evaluation showed effective urinary excretion without significant obstruction. Both patients who received calyceal-ureteral anastomosis reported satisfactory healing.

Conclusions: Effective management of pediatric grade IV renal trauma with urinary extravasation necessitates comprehensive imaging, with delayed CT scanning serving as the modality of choice when permissible. Regular follow-up via ultrasound or CT is critical for conservatively managed cases. Surgical intervention should be considered for patients with ongoing urinary extravasation, expanding urinoma, post-traumatic hydronephrosis, or suspected ureteropelvic junction disruption. The therapeutic approach, including ureteral stenting, renal laceration repair, or calyceal-ureteral anastomosis, should be tailored to the individual patient's condition.