Management of paediatric kidney trauma When can children safely participate in sporting activities again?
surgical to conservative management for most renal trauma cases has been seen in children and adults. While minimally invasive management through embolisation is used for the most severe or high-risk cases. Lack of guidelines for recovery The next stage of renal trauma, specifically recovery after renal trauma, has not been highlighted in literature. It remains unclear when it is safe to mobilise or even return to sporting activities after renal trauma. The answer to this question is not straightforward and will depend on the degree of renal trauma and what type of activity is being considered. However, it is an important clinical issue, especially for children. Children are typically more physically active than adults and also their return to school could be hindered due to lack of proper instructions. The urological guidelines provide no guidance regarding mobility and sporting activities after renal trauma. The surgical trauma guidelines state that mobility can be resumed when gross haematuria has ceased. Sporting activities may be recommenced when microscopic haematuria has stopped and within 2 – 6 weeks after renal trauma for the lower grades. For the more severe renal injuries, up to 12 months of no sports could be necessary. There is no mention of relevant factors that will influence the duration of immobility requirement. Evaluation As part of a Young Academic Urologists Working Group Paediatric Urology project, a survey was constructed to evaluate the clinical management of renal trauma. In regard to mobility and sporting activities, the survey responders reported a large variation in clinical management. For the low grade renal injuries almost all responders stated that it was safe to return to sporting activity, however, with variable time to return to sporting activity ranging from 2
– >12 weeks. In the case of higher grade injuries and conservatively managed penetrating trauma, the majority of respondents indicated that sporting activities could resume after >12 weeks, conversely, part of the respondents stated that no return to sports was possible. This is of significant importance for children, given that in some parts of Europe children will be prohibited from participating in sport ever again after renal injury. We can gain new insights by exploring the views on management of mobility and sports after trauma to other solid abdominal organs. For paediatric patients, the American Paediatric Surgical Association (APSA) have developed guidelines for blunt liver and spleen injury. According to the APSA guidelines, no bedrest is required after the injury and physical activity can be resumed after injury grade + 2 weeks [5]. These guidelines have been validated in a large cohort of 366 patients and were found to be safe [6]. The Arizona, Texas, Oklahoma, Memphis, Arkansas Consortium (ATOMAC) guidelines, also for blunt liver and spleen injury, specifically state that it is safe for children to return to school when comfortable and able [7]. Conclusion In order to determine the optimal management of mobility and sporting activity after renal trauma, further research is needed. The current guidelines for blunt liver and spleen trauma could be tested in the renal trauma setting. A prospective multi-centre study could be conducted to compare outcomes, such as return to mobility, time to return to sports, and complications between patients managed conservatively and those managed surgically. Additionally, the study should assess the impact of different factors, such as the grade of the injury and age on the outcomes.
renal trauma in paediatric patients, we want to highlight the importance of more clarity and evidence-based guidance for this group of patients. On behalf of the YAU Pediatric Urology Working Group: Fardod O’Kelly, Rianne Lammers, Anne- Françoise Spinoit, Bernhard Haid, Simone Sforza, Selçuk Silay, Numan Baydilli, Muhammet Irfan Donmez, Eduardo Bindi, Beatrix Bañuelos Marco References 1. Coccolini F, et al. WSES-AAST Expert Panel. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg. 2019 Dec 2;14:54. doi: 10.1186/s13017-019- 0274-x. 2. Morey AF, et al. Urotrauma: AUA guideline. J Urol 2014, 192: 327 3. Kitrey NC, et al. EAU Guidelines on Urological Trauma 2022. Edn. Presented at the EAU Annual Congress Amsterdam 2022. ISBN 978-94-92671-16-5. 4. Radmayr C, et al. EAU Guidelines on Paediatric Urology 2022. Edn. Presented at the EAU Annual Congress Amsterdam 2022. ISBN 978-94-92671-16-5. 5. Stylianos S. Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma Committee. J Pediatr Surg. 2000 Feb;35(2):164-7; discussion 167-9. doi: 10.1016/ s0022-3468(00)90003-4. 6. Notrica DM, et al. Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for paediatric blunt liver and splenic injuries (BLSI). J Paediatric Surg. 2019 Feb;54(2):335-339. doi: 10.1016/j. jpedsurg.2018.08.061. 7. Notrica DM, et al. Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015 Oct;79(4):683-93. doi: 10.1097/ TA.0000000000000808.
Dr. Lisette ‘t Hoen Paediatric Urology Department, Sophia Children’s Hospital, Erasmus Medical Centre, Rotterdam (NL)
Renal trauma is the most common urogenital trauma in children. In the case of blunt abdominal trauma, renal injury is found in 10-20% of instances. There is a higher risk for more severe injuries in children compared to adults because of their anatomical differences. The kidney is surrounded by less perirenal fat, a more elastic rib cage due to less ossification, weaker abdominal muscles and foetal kidney lobulations are still present. Blunt trauma is the main mechanism of injury to the kidney. The American Association for the Surgery of Trauma (AAST) scale is most commonly used to stratify severity of injury, ranging from
grades I – V. In 2019 the World Society of Emergency Surgery (WSES) kidney trauma
classification was introduced. This grading system specifies four grades and is based on the AAST scale, but also includes the hemodynamic status of the patient [1]. Clinical guidelines are provided by the American Urological Association (AUA) and European Association for Urology (EAU), including a separate guideline for paediatric renal trauma, from the perspective of the urologist [2-4]. The WSES-AAST have also developed guidelines for urogenital trauma from the surgical trauma perspective[1]. In these guidelines, detailed flowcharts are presented for diagnosis and acute management using the AAST and WSES grading systems. A shift from
Friday, 10 March 13:35 - 13:40 Thematic Session: Curiosities in paediatric urology Pink Area, Coral 7
Given the great variation that is presented in the management of mobility and sporting activity after
SOLTIVE Premium - SuperPulsed Thulium Fiber Laser All-in-One Versatile Plattform Designed for Lithotripsy, BPH and Soft Tissue
Stone Dusting in Half the Time of the leading Holmium YAG laser, and with impressive generation of finer particulate. 1
Virtually No Retropulsion Inherent stone stabilizing effect means less chasing of stone fragments and more control during lithotripsy. 2
Safety and Efficancy for BPH and Soft Tissue Precisely cutting through soft tissue and state-of-the-art prostate enucleation, with visibly improves hemostasis. 3
1 Data on file. Comparative laser system data collected on Lumenis P120. 2 At select settings. Data on file compared to Lumenis P120. 3 Data on file. Comparative laser system data collected on Lumenis P120. Improved hemostasis noted at 365 µm diameter fibers and larger.
Postbox 10 49 08, 20034 Hamburg, Germany | Phone: +49 40 23773-0 | www.olympus-europa.com
European Urology Today
February/March 2023
43
Powered by FlippingBook