Genitourinary trauma in the pediatric patient

McAleer, Irene M.; Kaplan, George W.; Scherz, Hal C.; Packer, Michael G.; Lynch, Frank P.

doi:10.1016/0090-4295(93)90274-e

Cited by 74 publications

(26 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The kidney injury was treated conservatively with no TPND in 17 (55%) children who had an isolated renal injury; two required surgical intervention 3 months after the trauma because of secondary urinary obstruction. Catheter placement was satisfactory in all seven procedures; the mean (range) duration of drainage was 18 (16)(17)(18)(19)(20)(21)(22) days in patients with isolated renal trauma, but was 4 (3-6) months in patients with a PERL. Obstruction and extravasation were successfully relieved and urinomas resolved in all seven patients.…”

Section: Resultsmentioning

confidence: 96%

“…Recently, several studies have shown that IVU has a very low yield and rarely alters the treatment in children with blunt renal trauma, especially in those with isolated microscopic haematuria [19,20]. However, abdominal CT not only confirms or excludes a diagnosis of renal injury with high accuracy, but also often diagnoses other solid organ injuries [18,21,22]. Contrast-enhanced helical CT can reliably detect traumatic renal injuries, including occlusion of the renal artery [21,23].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Blunt renal trauma in children with previously undiagnosed pre‐existing renal lesions and guidelines for effective initial management of kidney injury

Önen¹,

Kaya²,

Çığdem³

et al. 2002

BJU International

View full text Add to dashboard Cite

Objectives To record pre-existing renal lesions (PERL) found incidentally during evaluation for blunt renal trauma in children, determine their importance, suggest guidelines for the effective initial management of children with significant renal trauma and to evaluate the role of temporary percutaneous nephrostomy tube drainage (TPND) in these patients. Patients and methods We reviewed 338 children who were hospitalized with blunt abdominal trauma between 1992 and 2000. Thirty-one patients had significant renal injury, 17 before 1997 (reviewed retrospectively) and the others reviewed and followed prospectively. Results Eleven of the 31 children had a PERL, which had been undiagnosed before the injury. The mean (range) follow-up was 52 (15-104) months. There were 22 boys and nine girls (mean age 9.1 years, range 2-13).The mean age was lower in patients with a PERL than in children with isolated renal injury. The most common cause of blunt renal injuries was a fall (45%) followed by motor vehicle accidents. Renal stones were present in five children, pelvi-ureteric junction obstruction in four, megaureter in one and a renal cyst in one. The mean injury severity scores were 12in the children with a PERL and 14 in patients without. TPND was used in seven (22%) children; four were associated with a PERL. The mean grade of injury score for the kidney was higher in patients with a PERL and in children who underwent TPND than in patients who previously had a normal kidney and in children who did not undergo TPND. Early surgical intervention was required in three children; all were associated with a PERL. Of the 13 children who underwent surgery 11 had previous disease. Conclusions The frequency of PERL is high (36%) in children with blunt renal trauma. PERL can predispose minor trauma to cause kidney injury even with no evidence of hydronephrosis. When a minor trauma results in renal injury, it is important to seek a PERL.In selected patients, TPND may decrease the length of hospital stay and improve the outcome of the injured kidney, thereby decreasing the need for further surgery in those with isolated renal injury; however, it appears not to decrease the need for later operations in children with a PERL.

show abstract

Section: Resultsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Blunt renal trauma in children with previously undiagnosed pre‐existing renal lesions and guidelines for effective initial management of kidney injury

Önen¹,

Kaya²,

Çığdem³

et al. 2002

BJU International

View full text Add to dashboard Cite

show abstract

“…2-4,12,13 As per the Eastern Association for Surgery of Trauma Practice Management Guidelines Workgroup, CT cystography is as accurate as stress cystography in detecting BR and may be used interchangeably. 7,12,22 Subsequent studies have found that CT cystography may be superior to conventional stress cystography in detecting BR. 6 Our most common diagnostic modality was CT cystogram.…”

Section: 17mentioning

confidence: 99%

“…2,3,9 Gross hematuria is felt to be associated with more significant bladder injuries (aka BR). 4,5,16,22 We recommend that visible hematuria in association with a pelvic fracture warrants cystography.…”

Section: 17mentioning

confidence: 99%

“…16,19 Gross hematuria is the classic sign in BR. 5,7,11,16,[20][21][22] Patients may also present with abdominal tenderness, suprapubic bruising, shock, blood at the urethral meatus, abdominal distention, edema of perineum or upper thighs and urinary retention. 2,3,9 Gross hematuria is felt to be associated with more significant bladder injuries (aka BR).…”

Section: 17mentioning

confidence: 99%

See 1 more Smart Citation