Genitourinary trauma in the pediatric patient

doi:10.1016/0090-4295(93)90274-E

Urology

Volume 42, Issue 5, November 1993, Pages 563-567

https://doi.org/10.1016/0090-4295(93)90274-E Get rights and content

Abstract

Trauma is the major source of mortality in the pediatric population. A retrospective review was performed on patients admitted to the Children's Hospital and Health Center Trauma Program, San Diego, California, from August 1984 to May 1990. The purpose of this review was to evaluate pediatric trauma and to determine the best treatment and evaluation for genitourinary injuries. Blunt trauma was responsible for 98 percent of the injuries, with renal injuries being the most common. Bladder (70%) and male urethral (2) injuries, and vaginal lacerations (8) also occurred. The most severe renal injuries (70%) and all significant bladder and urethral injuries were associated with gross hematuria. Hypotension was present in 31 percent of patients but rarely required surgical exploration for correction. Eighty-six patients underwent radiographic imaging. Computerized tomography (CT) scans demonstrated the most information about intra-abdominal solid organ injuries but was inaccurate in detecting bladder or urethral injuries. Cenitourinary injury is common in children but rarely requires surgical management. CT scan is the best study to determine extent of solid-organ injury but is inferior to cystourethrography to diagnose bladder or urethral injuries.

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Pediatric genitourinary injuries: 7-year experience at the largest tertiary referral hospital in Eastern part of Indonesia
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The anatomical variations between children and adults render pediatric patients more prone to urogenital trauma. However, it is not known for certain whether children are more prone to genitourinary trauma than adults. The aim of the study is to scrutinize the characteristic of pediatric genitourinary trauma at, the largest tertiary hospital in Eastern part of Indonesia.
The design of the study was analytic retrospective gathering medical records of all pediatric patients with urogenital trauma with total sampling. The number of patients, ages, genders, etiology, locations, and management were collected. Data was statistically analyzed using SPSS®, and p < 0.05 was considered statistically significant.
We found 13.5 (10–15.5) years as the median age in our 60 samples. Boy (75.00%), renal trauma (56.67%), abdominal and pelvic trauma (96.67%), traffic accident (91.67%), suprapubic catheterization (52.17%), and hemodynamically stable (91.67) was among the majority. We also found that non-operative management was in majority. Statistical analysis demonstrated significant differences for management and grade of injury (p < 0.05).
This is, to the best of our knowledge, the first study of genitourinary injuries in children who were treated at a tertiary hospital in Indonesia during the course of the 7-year research period. The limitations of this study are retrospective character and conducted in single institution.
The highest incidence of pediatric urogenital trauma is renal trauma due to traffic accident, which often multitrauma. Future prospective multi-center studies should be done to corroborate the results.
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Pediatric pelvic trauma is not common, but the presence of pelvic fractures is concerning for additional injuries. Bladder rupture most commonly is the result of blunt trauma to a full bladder. Plain radiography is often employed when pelvic trauma is suspected and the presence of a pelvic fracture on plain radiography may prompt further imaging, such as computed tomography. There are recommendations that if a patient is to undergo computed tomography, plain radiography of the pelvis is not indicated, since the bones of the pelvis are well visualized with computed tomography. If bladder rupture is suspected by clinical examination or laboratory findings, then cystography should be performed, either with plain radiography or computed tomography (the more commonly used modality).
Does Microscopic Hematuria After Pediatric Blunt Trauma Indicate Clinically Significant Injury?
2019, Journal of Surgical Research
Citation Excerpt :
Trauma is the leading cause of morbidity and mortality in children.1 Urinary system injury after trauma is relatively uncommon.2-4 Only 10% of patients admitted to a trauma service have a genitourinary system injury.5
Children are more likely to have urinary system injury after blunt abdominal trauma (BAT) because of anatomical vulnerabilities. Urinalysis (UA) is often performed during initial evaluation to screen for injury. The purpose of this study was to determine how often finding microscopic hematuria after BAT leads to further testing and whether this indicates a significant injury.
A retrospective review of children evaluated for BAT at Children's Health from 2013 to 2017 was performed. Patients included had microscopic hematuria on initial UA. Data collected included demographics, injury data, laboratory and imaging data, and outcomes. Analysis was performed using descriptive statistics, Fisher's exact, and independent t-test.
Of 1059 patients treated for BAT during the study period, 203 (19%) exhibited microscopic hematuria on UA during the initial workup. Most UAs resulted after imaging was completed and did not impact management (158, 78%); twenty-two (14%) of these patients had urinary injury, which were diagnosed by imaging regardless of UA results. Forty-five (22%) patients were found to have microscopic hematuria that independently led to workup for urinary injury. Of these, nine patients had a urinary system injury: 6 low-grade renal and three bladder wall injuries, none of which required surgery. Those with and without urinary injury in this group underwent similar numbers of radiographic studies.
Microscopic hematuria on screening UA after BAT may lead to extensive workup, regardless of the presence of symptoms. In patients who receive cross-sectional abdominal imaging, preceding UA adds little to the clinical workup of children with BAT.
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2016, Surgical Clinics of North America
Repair of pediatric bladder rupture improves survival: Results from the National Trauma Data Bank
2012, Journal of Pediatric Surgery
The urinary bladder is the second most commonly injured genitourinary organ. The objective of this study was to describe the management of pediatric traumatic bladder ruptures in the United States and their association with surgical repair and mortality.
We searched the 2002-2008 National Trauma Data Bank for all pediatric (<18 years old) subjects with bladder rupture. Demographics, mechanism of injury, coexisting injury severity, and operative interventions for bladder and other abdominal trauma are described. Multivariate logistic regression analysis was used to examine the relationship between bladder rupture and both bladder surgery and in-hospital mortality.
We identified 816 children who sustained bladder trauma. Forty-four percent underwent bladder surgery, including 17% with an intraperitoneal injury. Eighteen percent had 2 intra-abdominal injuries, and 40% underwent surgery to other abdominal organs. In multivariate analysis, operative bladder repair reduced the likelihood of in-hospital mortality by 82%. A greater likelihood of dying was seen among the uninsured and those with more severe injuries and multiple abdominal injuries.
After bladder trauma, pediatric patients demonstrate significantly improved survival when the bladder is surgically repaired. With only 67% of intraperitoneal bladder injuries being repaired, there appears to be underuse of a life-saving procedure.
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^☆: The opinions expressed in this article are those of the authors and do not represent the opinions of the Department of the Navy, Department of Defense, or the United States Government.

^∗: Department of Urology National Naval Medical Center Bethesda, Maryland 20889-5000

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Genitourinary trauma in the pediatric patient☆

Abstract

J Urol

Pediatr Clin North Am

Urology

Urol Clin North Am

Urol Clin North Am

Pediatr Clin North Am