Association of Injury Risk Factors With Intervention For Urinary Extravasation in Pediatric High-Grade Renal Trauma

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVES: High-grade renal trauma(HGRT; American Association for the Surgery of Trauma Renal (AAST)Grade IV and V) complicated by urinary extravasation (UE) is often managed non-operatively, with 79-90% of UE cases resolving spontaneously within 48-72 hours. While guidelines for bleeding interventions are robust, evidence for collecting system injury management remains limited. Here we sought to identify factors associated with collecting system intervention in pediatric HGRT complicated by UE to guide clinical decision-making. METHODS: Using the Multi-institutional Pediatric Acute Renal Trauma Study (Mi-PARTS) retrospective cohort, we identified 119patients who suffered blunt HGRT with collecting system injuries identified on imaging. Collecting system interventions included ureteral stent placement, percutaneous nephrostomy tube placement, or peri-renal drain placement. Multivariable logistic regression was performed to identify independent risk factors of intervention. The model included age, sports injury mechanism, AAST Renal Injury Grade V (vs. IV), abscess/urinoma, pyelonephritis/urosepsis/UTI, concomitant solid organ injuries, and persistent gross hematuria. RESULTS: The cohort had a median age of 11.8 years and was66% male. 51 patients (43%) underwent collecting system interventions. 108 patients (91%) had AAST Renal Grade IV injuries, while 11 (9%) had Grade V injuries. Multivariable analysis identified three independent factors associated with interventions for urinary extravasation: sports-related mechanism of injury (OR 2.85, 95% CI1.06-8.01, p=0.041), AAST Grade V injury (OR 8.17, 95% CI 1.81-58.5, p=0.013), and abscess/urinoma formation (OR 9.53, 95% CI2.2-66.5, p=0.007) (Table 1). CONCLUSIONS: Sports-related injury mechanisms, AAST Renal Grade V injuries, and presence of abscess or urinoma were significantly associated with the need for collecting system interventions. Our findings suggest that sports-related injuries warrant close monitoring given their independently elevated risk beyond injury severity alone. Further studies are needed, including in depth analysis of imaging features, to assess whether additional risk factors for persistent urinary extravasation can be identified.

Volume

215

Issue

5S

First Page

e677

Last Page

e677

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

DOI

10.1097/01.JU.0001191472.40725.fe.01

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