Early ureteral stenting may be considered for pediatric patients with multiple sites of extravasation or lack of contrast in the ipsilateral ureter on a CT scan which reveals Grade IV renal injury.

In a study presented during the recent 2007 American Urological Association’s Annual Meeting Dr. Glenn M Cannon Jr. M.D. and colleagues from the University of Pittsburgh have found that early ureteral stenting may be considered for patients with multiple sites of extravasation or lack of contrast in the ipsilateral ureter on a CT scan which reveals Grade IV renal injury.

Dr. Cannon states: "Conservative management is initially undertaken in all patients with blunt renal trauma at our hospital with ureteral stenting reserved for symptomatic urinomas.

“We wished to determine if certain findings were predictive of the need for delayed intervention so that the decision to intervene could be made earlier”.

Dr. Cannon and his team of researchers retrospectively reviewed their trauma database, which revealed 117 consecutive patients treated for renal trauma from 2000-2006. In this data base, 13 patients were identified with Grave IV blunt renal trauma. The initial CT scan was then reviewed to determine location, size, number and site of urinary extravasation as well as the presence of contrast in the ipsilateral ureter. To determine if certain findings always resulted in delayed surgery; researchers compared subsequent ureteral stent placement, percutaneous urinoma drainage, angiographic embolization, or nephrectomy with the CT findings.

The results showed 11 male and two female patients with a median age of ten years were identified. Eight patients had extravasation from the renal pelvis or anterolateral portion of the kidney. Four patients underwent stent placement that included one also having a urinoma drainage and one underwent nephrectomy.

The researcher’s note, patients who required intervention had multiple sites of extravasation (2), no contrast in the ipsilateral ureter (1), or wide separation of the upper and lower pole collecting systems by urinoma (1). Two of the five patients required transfusion, one of which required selective embolization. The mean size (7.1 vs. 5.1mm, p=0.35) and location of the leak were not predictive.

They also concluded that early intervention could have shortened recuperation by 5.2 days and hospitalization by 1.8 days. Of the five patients with posterior extravasation, two had spontaneous resolution, one had percutaneous drainage, and one had laparoscopic decortication for symptomatic urinoma.

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