Use of ureteral stents in the management of major renal trauma with urinary extravasation: Is there a role?

Five patients with major (Grade IV) renal trauma required ureteral stent pl acement to facilitate urinary drainage. Three of these patients had stents placed for recurrent gross hematuria with flank pain. All three had obstruc ting blood clots present at the time of stent placement. The fourth patient had a stent placed because of persistent extravasation at 2 weeks postinju ry, The last patient was considered at risk for persistent urinary extravas ation because of a partial ureteropelvic junction obstruction and had a ure teral stent placed as part of the initial management. All patients were fol lowed radiographically for resolution of extravasation, Long-term clinical follow-up consisted of serum creatinine evaluation and blood pressure monit oring. Urinary extravasation resolved in all five patients, as determined b y radiologic evaluation, at a mean of 8 days after stent placement. Uretera l stents were left indwelling an average of 4 weeks. No patient developed h ypertension, and all serum creatinine values were normal at a mean 26 month s' follow-up, No patient developed urinoma or abscess, and none required op en surgical exploration. Ureteral stents may be used safely and effectively to treat persistent or recurrent urinary extravasation resulting from majo r blunt renal trauma in appropriately selected patients. In addition, urete ral stents may avoid the need for surgical exploration in patients with Gra de IV renal trauma who develop recurrent gross hematuria, Bank pain, and pe rsistent or recurrent extravasation secondary to clot obstruction.