PEDURO 2014 V. National Pediatric Urology Congress

Aim: To present our experience about the children who have been followed and treated due to serious renal injuries.
Material and method: A total number of 31 children have been assessed in our clinic who have been folowed and treated due to serious renal trauma (Grade IV, V ) between 2009 and 2014.
Findings: The 21(48%) of events were male and 10(32%) were female. The average age of the patients was 10±4.7 (1-18) years. 13(42%) out of 31 patients were grade 4 and 18(58%)  were grade 5. 27 (87%) of traumas were blunt and 4(13%)  were developed due to penetran injury. The most frequent was developed depending on the falling down from height(67%). The right kidney injury were observed in 19(61%) patients and left kidney injury were observed in 12(39%) patients. In the BT analysis it has been observed that, there is additional organ injury in  16(52%) patients and there is no additonal organ injury in  15(48% ) patinets. The most often injured additional organs were lungs with 29 % and liver with 13 %. There have been early or late transfusion need with 18 (58%) patients and no need with 13(42%) patinets. In 26 (84 %) of patients the conservative was observed and 5 patients have been interfered. DJ stent performed in two of them, two patients were did nefrectomy (colon perforation, emergency splenectomy) and one patients were did urgent to repair the kidney. 28 (90%) of patients were lived however, the three (10 %) patient who was grade V renal trauma and were multiple trauma, have been lost. Urinoma have been developed in 4 (17%) of patients, and hypertension / atrophic kidney have been developed in 1 (5%) patient.
Results
The majority of renal traumas can be treated conservatively. The severity of the trauma and accompanying organ injury can increase rates of nefrectomy and mortality .

Amaç: Şiddetli renal travma nedeniyle takip ve tedavi edilen çocuklarla ilgili tecrübelerimizi sunmaktır.
Gereç ve yöntem: 2009-2014 yılları arasında kliniğimizde ciddi (Grade IV, V ) renal travma nedeniyle takip ve tedavi edilen 31 çocuk değerlendirildi.
Bulgular: Olguların 21(48%)’i erkek, 10(32%) kız idi. Hastaların ort yaşı 10±4.7 (1-18) yıl idi. 31 hastanın 13(42%)’ ü  grade 4, 18(58%)’i grade 5 idi. Travmaların 27’si (87%) künt, 4’ü (13%)  penetran yaralanmaya bağlı oluşmuştu. En sık yüksekten düşmeye 15(48%) bağlı, oluşmuştu. Sağ böbrek yaralanması 19(61%), sol böbrek yaralanması ise 12(39%) hastada olmuştur. Yapılan BT incelemede 16 (52%) hastada ek organ yaralanması var iken, 15 (48% ) hastada ek organ yaralanması yoktu.  En sık yaralanan ek organlar akciğer (%29) ve karaciğer (%13) olmuştur. Hastaların 18’inde (%58) erken dönem veya geç dönemde transfüzyon ihtiyacı olurken, 13(%42) hastada transfüzyon ihtiyacı oluşmamıştır. Hastaların 26’si (%84) konservatif izlenirken 5(%16) hastaya müdahale edildi. Bu hastaların  2’ sine Dj stent kondu, 2(% 6) hastaya acil nefrektomi (kolon perforasyonu, acil splenektomi), 1(%3) hastaya acil nefrorafi uygulandı. Hastaların 28’i (90%) yaşarken, grade V renal travması olan 3 multiple travmalı hasta  (10 %) kaybedilmiştir. Geç komplikasyon olarak 4 (13%) hastada ürinom, bir (5%) hastada HT/atrofik böbrek görüldü.
Sonuçlar: Renal travmaların büyük çoğunluğu konservatif tedavi edilebilir.Travma ve eşlik eden organ hasarının şiddeti hastada nefrektomi ve ölüm oranlarını artırabilir.