[size=20px]A 7-year-old boy fell out of his bedroom window and is found to have a grade 3 left renal injury with hematuria. He is sent home the next day but returns 7 days later with persistent hematuria and increased left flank pain. A CT scan of the abdomen demonstrates a 7 cm urinoma lateral to the kidney with contrast extravasation. The most appropriate management strategy is:

 

A Foley catheter placement

 

B Ureteral stent placement via cystoscopy

 

C Percutaneous drainage

 

D Segmental renal artery embolization

 

E Partial nephrectomy​[/size]

C

C

correct answer

B Ureteral stent placement via cystoscopy

 

Early discharge after blunt renal injury is appropriate, even in the presence of hematuria. However, intervention may become necessary if symptoms worsen. Indications for intervention with a traumatic urinoma include increasing pain, size over 4 cm, expansion, ileus and extravasation of contrast beyond 20 days. This patient has increased pain and a large urinoma. Ureteral stent placement via cystoscopy is a good option as it avoids the discomfort and dislodgement risk associated with a percutaneous drain. Percutaneous drain insertion may become necessary if the urinoma expands despite placement of a ureteral stent.​ Partial nephrectomy is not indicated in this situation and angioembolization would only be employed for a pseudoaneurysm. ​

 

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