Çocuklarda Genitoüriner Sistem Travmaları

Abstract

Amaç: Bu çalışma ile genitoüriner sistem (GÜS) travmalarının oluş mekanizması, tedavi yaklaşımları ve uzun dönem izlem sonuçları değerlendirilerek renal travma (RT) üzerine etki eden faktörlerin belirlenmesi hedeflendi.Gereç ve Yöntemler: Şubat 2010 ile Temmuz 2012 tarihleri arası GÜS travması geçiren hastaların dosyaları geriye dönük olarak incelenerek yaş, cinsiyet, travma tipi ve şiddeti, ek travma varlığı, takip, tedavi açısından verileri toplandı. RT’ler Travma Organ Şiddet Ölçeğine göre grade 4 ve 5 olanlar şiddetli, diğerleri şiddetli olmayan olarak ayrıldı. Grade 2 ve üzeri travma skoru olanlar böbrek fonksiyonu açısından sintigrafik olarak değerlendirildi.Bulgular: Yaşları ortalama 8.82±3.83 (ortanca 8.5y) olan 21’i erkek, 13’ü kız 34 olgu değerlendirmeye alındı. RT 22 olguda, ekstrarenal GÜS travması 12 olguda mevcuttu. Araç dışı trafik kazası (ADTK) 11, araç içi trafik kazası (AİTK) 4, yüksekten düşme (YD) 17 ve patlama sonrası yaralanma 2 olguda tespit edildi. RT’lerden sadece 4’ü (%18) grade 4 ve 5 idi. 13 renal ve 12 ekstrarenal olguda hematüri mevcuttu. RT hastalarının 7’si izole iken 15’inde ise ek travma mevcuttu. RT’lerin 15’i sağ, 7’si sol lokalizasyonluydu. Grade 2 ve üzeri renal travması olan 8 hastadan 4’ünde sintigrafide böbrek fonksiyonlarında düşme tespit edildi. Şiddetli RT’si olan 2 hastada ekspanse olan perirenal koleksiyon nedeni ile jj kateter takılırken, ekstarenal travması olan 9 hastaya operasyon yapıldı. Ekstrarenal yaralanmalarda daha fazla operasyon ihtiyacı ve hematüri tespit edildi. ADTK’larda RT oranları düşük, ekstrarenal ürogenital yaralanmaların oranı yüksek, AİTK’da ve YD’de ise bunun tam tersi geçerliydi. Şiddetli RT’lerde yatış süresi, hematüri, operasyon ihtiyacı, böbrek fonksyonlarında düşme, sol RT oranı, hafif-orta RT’lere göre anlamlı derecede yüksek ayrıca sol RT’lerde böbrek fonksyonlarında düşme sağ RT’lere göre anlamlı derecede yüksek bulundu. Diğer parametreler açısından gruplar arası fark tespit edilmedi.Sonuç: Çocuklarda YD ve AİTK’larında daha fazla oranda RT gerçekleşmektedir. Bu yüzden bu tip travmalarda RT olacağı akılda tutulup buna göre tetkikler planlanmalıdır.

Keywords

• Travma, Ürogenital sistem

Genitourinary System Trauma in Children

Abstract

Objective: Patients who suffered from blunt trauma to the genitourinary system (GUS) were evaluated retrospectively for factors related to renal trauma (RT).Material and Methods: Information (age, gender, type and severity of trauma, presence of additional organ injury, follow-up and treatment data) of patients who had experienced GUS trauma between February 2010 and July 2012 were collected from the patient charts. Grade 4 and 5 RT’s were recorded as severe according to the trauma organ severity scale and RT’s above grade 2 were investigated using DMSA scintigraphy. Results: A total of 34 patients consisting of 21 males and 13 females (mean age 8.82) were reviewed. There were 22 cases of RT and 12 cases of extrarenal GUS trauma. There were also 11 Vehicle out Traffi c Accidents (VOTA), 4 Vehicle in Traffi c Accidents (VITA), 17 Falling from Height (FFH), and 2 explosion injury cases were detected. Grade 1 and 2 RT’s were most common but 4 patients (18%) had grade 4 and 5 RT. Hematuria was present in 13 renal and 12 extrarenal cases. The RT was isolated in 7 and together with additional organ injury in 15 cases. The location was the right side in 15 and the left side in 7 RT cases. There were 8 patients who had grade 2 and higher grades of injury and renal scintigraphy revealed decreased function in 4 of these children. A JJ stent was inserted for an expanding perirenal collection in 2 patients. Surgery was required for 9 patients who had exrarenal trauma. The rates of hematuria and surgery were higher in the extrarenal trauma group. The RT rate was low and the extrarenal GUS trauma rate high in the VOTA group while the opposite was true in the VITA and FFH groups. Hospitalization time, hematuria, need for surgery, scintigraphy results revealing decreased renal function, and left RT rates were signifi cantly higher in the severe RT group compared with the non-severe RT group. Scintigraphy results revealing decreased renal function rates were also more common in left RT cases when compared with right RT cases. There was no difference in terms of other parameters. Conclusion: RT rates are higher in children with FFH and VITA so appropriate studies are required

Keywords

• Trauma, Urogenital system

References

1. Koltuksuz U, Gürsoy MH. Çocuklarda genitoüriner travmalar. Turgut Özal Tıp Merkezi Dergisi 1998;5:97-104.
2. McAleer IM, Kaplan GW, Sherz HC, Packer MG, Lynch FP. Genitourinary trauma in the pediatric patient. Urology 1993;42:563- 8.
3. Brown SL, Elder JS, Spirnak JP. Are pediatric patients more susceptible to major renal injury from blunt trauma? A comparative study. J Urol 1998;160:138-40.
4. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: Spleen, liver, and kidney. J Trauma 1989;29:1664-6.
5. Casale AJ. Genitourinary Trauma in Children, Urologic Surgery Infants and Children, In: King LR (ed), Philedelphial Saunders, 1997: 264.
6. McAleer IM, Kaplan GW: Pediatric genitourinary trauma. Urol Clin North Am 1995; 22:177-88.
7. Radmayr C, Oswald J, Müller E, Höltl L, Bartsch G. Blunt renal trauma in children: 26 years clinical experience in an alpine region. Eur Urol 2002;42:297-300.
8. He B, Lin T, Wei G, He D, Li X. Management of blunt renal trauma: An experience in 84 children. Int Urol Nephrol 2011;43:937-42.

9. Rogers CG, Knight V, MacUra KJ, Ziegfeld S, Paidas CN, Mathews RI. High-grade renal injuries in children-Is conservative management possible? Urology 2004;64:574-9.
10. Henderson CG, Sedberry-Ross S, Pickard R, Bulas DI, Duffy BJ, Tsung D, et al. Management of high grade renal trauma: 20-year experience at a pediatric level I trauma center. J Urol 2007;178: 246-50.
11. Sharp DS, Ross JH, Kay R. Attitudes of pediatric urologists regarding sports participation in children with a solitary kidney. J Urol 2002;168:1811-4.
12. Hashmi A, Klassen T. Correlation between urinalysis and intravenous pyelography in pediatric abdominal trauma. J Emerg Med 1995;13:255-8.
13. Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg 2006;244:620-8.
14. Keller MS, Eric Coln C, Garza JJ, Sartorelli KH, Christine Green M, Weber TR. Functional outcome of nonoperatively managed renal injuries in children. J Trauma 2004;57:108-10.
15. Bozeman C, Carver B, Zabari G, Caldito G, Venable D. Selective operative management of major blunt renal trauma. J Trauma 2004;57:305-9.
16. Yang CS, Chen IC, Wang CY, Liu CC, Shih HC, Huang MS. Predictive indications of operation and mortality following renal trauma. J Chin Med Assoc 2012;75:21-4.
17. Nance ML, Lutz N, Carr MC, Canning DA, Stafford PW. Blunt renal injuries in children can be managed nonoperatively: Outcome in a consecutive series of patients. J Trauma 2004;57:474-8.
18. Baumann L, Greenfi eld SP, Aker J, Brody A, Karp M, Allen J, et al. Nonoperative management of major blunt renal trauma in children: In-hospital morbidity and long-term followup. J Urol 1992;148: 691-3.
19. Philpott JM, Nance ML, Carr MC, Canning DA, Stafford PW. Ureteral stenting in the management of urinoma after severe blunt renal trauma in children. J Pediatr Surg 2003;38:1096-8.
20. Netter FH. Anatomy structure and embryology. In: The Netter Collection of Medical Illustrations, Volume 6, Pittsburg, Pa: Kidneys Ureters and Urinary Bladder, Novartis Publication, 1997:1-35.