386 THE JOURNAL OF UROLOGY ® Vol. 179, No. 4, Supplement, Monday, May 19, 2008 grade 2, 13 were grade 3, 3 were grade 4. The observed actuarial survival Patients diagnosed with local or regional disease demonstrated better respectively). CONCLUSIONS: Pediatric RCC is an uncommon tumor and, over 17 years of investigation, only 43 cases were reported. This is the largest cohort of pediatric RCC reported in the literature. These data show that RCC occurs most frequently in children in the second decade of life, more often in girls, and African Americans. This cohort suggests that RCC in children is an aggressive disease, with over 25% of cases presenting with metastatic disease and increased mortality in those cases. The epidemiological characteristics of this tumor differ from adult RCC and Wilm’s tumor, suggesting its unique biology and potential need for unique treatment. Source of Funding: None 1121 NON-OPERATIVE MANAGEMENT OF GRADE IV BLUNT RENAL TRAUMA IN CHILDREN: A META-ANALYSIS REVIEW Eric C Umbreit*, Jonathan C Routh, Douglas A Husmann. Rochester, MN. INTRODUCTION AND OBJECTIVE: Controversy regarding the management of grade IV blunt renal trauma in children with open surgical exploration versus non-operative management has existed for decades. We performed a meta-analysis review of the published literature to evaluate the effectiveness of non-operative strategies in managing grade IV blunt pediatric renal trauma. METHODS: We conducted a systematic review of the English literature using the Medline, EMBASE, Cochrane and Scopus databases (1992-2006). Bibliographies of included studies were also hand-searched. Only publications using the American Association of the Surgery of Trauma renal injury scale were included. Papers and data were excluded that did not classify the severity of the injury. Only patients reviewed in duplicate with differences resolved by consensus. RESULTS: In the 292 papers reviewed, data could be gathered on 91 children with grade IV renal lacerations. All 91 children underwent a trial of conservative management. No intervention was required in 73% of the patients (66/91). Symptomatic urinoma (prolonged ileus, fever, etc.) developed in 15% (14/91). In patients with a symptomatic urinoma, 76% (11/14) were successfully managed by percutaneous drainage or ureteral stent placement. Open intervention to manage complications became necessary in the remaining 24% (3/14). Two patients had concurrent UPJ disruptions that were initially undiagnosed, both patients eventually underwent nephrectomy. One patient had a simultaneous severe renal pelvis laceration requiring operative repair. Angiographic infarction and/or surgical exploration due to hemodynamic instability became necessary in 12% (11/92). In these patients, 46% (5/11) required a partial nephrectomy, 27% (3/11) underwent nephrectomy, and 27% (3/11) were salvaged. Overall, renal function was preserved, at least in part, in 95% (86/91) of the patients. CONCLUSIONS: In children with grade IV renal injuries a non-operative management treatment protocol saved 73% (66/91) of the patients from any form of intervention. Open exploration became necessary in 15% (14/91). Renal function was preserved, at least in part, in 95% (86/91) of the patients. Source of Funding: None 1122 SERIAL IMAGING STUDIES AFTER RENAL TRAUMA IN CHILDREN – IS ULTRASOUND ENOUGH? Kurt R Eeg, Sarel Halachmi, Luis H Braga, Walid A Farhat, Darius J Bagli, Joao L Pippi Salle, Antoine E Khoury, Armando J Lorenzo*. Toronto, ON, Canada. INTRODUCTION AND OBJECTIVE: After renal injury, which most admitted patients will undergo radiological re-evaluation with either a repeat CT scan or ultrasound (US). The former imaging study is has been associated with possible future increased risk of malignancy. The ALARA (As Low As Reasonable Achievable) concept attempts to strike a balance between such risk and the added information obtained by exposure to radiation. At our institution the use of US has been adopted as the follow-up imaging technique of choice, with selective evaluation with CT scan. This retrospective study aims to evaluate the value of this practice in acute post-renal trauma re-evaluation. METHODS: A retrospective analysis of a large pediatric referral center trauma database was carried out, extracting data for patients managed between 1997 and 2007. A total of 73 children with renal of trauma, management, imaging studies obtained during hospital stay, RESULTS: Mean age at time of injury was 10.4 years, with a 3:2 male/female ratio. In all patients the mechanism was blunt injury. Average grade of injury on admission (by CT scan) was 2.4, high grade (IV or V) in 32%. Associated injuries were detected in 67%. A repeat CT scan was obtained in 11 patients, in 81% of cases for management of non-urologic injuries. Two patients had repeat CT scan for evaluation (1). Three nephrectomies were required in the setting of hemodynamic instability. Four enlarging urinomas were suspected by US and required stent or drain placement. No missed injuries or complications due to delayed diagnosis were detected in patients followed with US. At last follow-up 5 patients developed hypertension, all with an abnormal US. Patients with grade I and II injuries (n=41) did not have renal complications or missed urological injuries. CONCLUSIONS: Our experience suggests that after initial CT scan, monitoring can be performed with US in most cases (Excluding patients with hemodynamic instability or deemed to require CT scanning for associated injuries). Selective re-evaluation with CT scan can be reserved for those with abnormalities detected on serial US, thus decreasing exposure to radiation. Application of the ALARA principle appears feasible in the setting of pediatric blunt renal trauma. Source of Funding: None 1123 MANAGEMENT OF MAJOR PEDIATRIC RENAL TRAUMA, SINGLE CENTER EXPERIENCE Ahmad Zakaria, Hani A Morsi*, Ali M Ziada, Enmar Habib, Eissa Kotb, Mahmoud Daw, Mohamed A Eissa. Cairo, Egypt. INTRODUCTION AND OBJECTIVE: The study aims to review impact of major pediatric renal trauma on long-term function and morphology of the injured kidney. METHODS: 31 trauma patients (17 males & 14 females) presented between July 2005 and June 2007. Blunt trauma was the cause in all but one patient. Age ranged from 2 days to 14 years (mean grade 5 injuries. Followup ranged from 1-30 (mean 10) months. Patients were managed conservatively unless vitally unstable. RESULTS: Conservative management group (21 patients, 65.6%) included all grade 3 injuries and 10 of 13 grade 4 injuries. 5 excellent outcome in 16 of 21 patients (76.2%) with preserved kidney function, no urinary extravasation and hematoma resolution. The remaining patients had lower polar infarction (1), renal atrophy (1), persistent subcapsular collection (2) & 1 mortality related to CNS injury. Surgical intervention group (11 patients, 34.4%) included all grade 5 renal injuries, 3 of 13 grade 4 cases (23%). Surgical repair of lacerations in 6 cases, partial nephrectomy in 3 cases and nephrectomy in 2 cases. One patient had persistent bleeding requiring a segmental Creatinine. CONCLUSIONS: Our outcome of pediatric major renal trauma was overall favorable. Reduced kidney function occurred in 4 cases (12.5%). Only 2 cases ended in nephrectomy (6.25%). Longer followup is needed for renal function and development of hypertension. Source of Funding: None