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Pediatric Genitourinary Trauma

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Abstract

Children are at higher risk of blunt renal trauma due to the size and location of the pediatric kidneys as well as decreased perirenal fat, less developed abdominal muscles, and a less ossified thoracic cage. Renal injuries account for 5–20% of pediatric blunt abdominal trauma. The vast majority of children with blunt renal trauma have multi-organ injuries to the spleen, liver, head, and bones. A growing body of evidence suggests that hemodynamically stable pediatric blunt renal injuries can be managed conservatively.

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References

  • Abdalla MA. A posterior sagittal pararectal approach for repair of posterior urethral distraction injuries. Eur Urol. 2008;53(1):191–6.

    Article  PubMed  Google Scholar 

  • Al Ansari A, Talib RA, Shamsodini A, Hayati A, Canguven O, Al Naimi A. Which is guilty in self-induced penile fractures: marital status, culture or geographic region? A case series and literature review. Int J Impot Res. 2013;25(6):221–3.

    Article  PubMed  Google Scholar 

  • Andrich DE, Mundy AR. The nature of urethral injury in cases of pelvic fracture urethral trauma. J Urol. 2001;165(5):1492–5.

    Article  CAS  PubMed  Google Scholar 

  • Andrich DE, Day AC, Mundy AR. Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring. BJU Int. 2007;100(3):567–73.

    Article  PubMed  Google Scholar 

  • Ashley RA, Husmann DA. Artificial urinary sphincters placed after posterior urethral distraction injuries in children are at risk for erosion. J Urol. 2007;178(4 Pt 2):1813–5.

    Article  PubMed  Google Scholar 

  • Badawy H, Soliman A, Ouf A, Hammad A, Orabi S, Hanno A. Progressive hair coil penile tourniquet syndrome: multicenter experience with 25 cases. J Pediatr Surg. 2010;45(7):1514–8.

    Article  PubMed  Google Scholar 

  • Balkan E, Kilic N, Dogruyol H. The effectiveness of early primary realignment in children with posterior urethral injury. Int J Urol. 2005;12(1):62–6.

    Article  PubMed  Google Scholar 

  • Barett K, Braga LH, Farrokhyar F, Davis TO. Primary realignment versus suprapubic cystostomy for the management of pelvic fracture associated urethral injuries: a systematic review and meta-analysis. Urology. 2014;83(4):924–9.

    Article  Google Scholar 

  • Bartley JM, Santucci RA. Computed tomography findings in patients with pediatric blunt renal trauma in whom expectant (nonoperative) management failed. Urology. 2012;80(6):1338–43.

    Article  PubMed  Google Scholar 

  • Ben Chaim J, Livne PM, Binyamini J, Hardak B, Ben-Meir D, Mor Y. Complications of circumcision in Israel: a one year multicenter survey. Isr Med Assoc J. 2005;7(6):368–70.

    PubMed  Google Scholar 

  • Buckley JC, McAninch JW. Pediatric renal injuries: management guidelines from a 25-year experience. J Urol. 2004;172(2):687–90.

    Article  PubMed  Google Scholar 

  • Ceylan K, Burhan K, Yilmaz Y, Can S, Kuş A, Mustafa G. Severe complications of circumcision: an analysis of 48 cases. J Pediatr Urol. 2007;3(1):32–5.

    Article  PubMed  Google Scholar 

  • Chopra P, St-Vil D, Yazbeck S. Blunt renal trauma-blessing in disguise? J Pediatr Surg. 2002;37(5):779–82.

    Article  PubMed  Google Scholar 

  • Dalton BGA, Dehmer JJ, Shah SR. Blunt renal trauma. J Pediatr Intensive Care. 2015;4(1):16–20.

    Article  PubMed  PubMed Central  Google Scholar 

  • Deibert CM, Glassberg KI, Spencer BA. Repair of pediatric bladder rupture improves survival: results from the National Trauma Data Bank. J Pediatr Surg. 2012;47(9):1677–81.

    Article  PubMed  Google Scholar 

  • Djordjevic ML, Bumbasirevic MZ, Krstic Z, Bizic MR, Stojanovic BZ, Miocinovic R, Santucci RA. Severe penile injuries in children and adolescents: reconstruction modalities and outcomes. Urology. 2014;83(2):465–70.

    Article  PubMed  Google Scholar 

  • Dokucu AI, Ozdemir E, Oztürk H, Otçu S, Onen A, Ciğdem K, Kaya M, Bükte Y, Yücesan S. Urogenital injuries in childhood: a strong association of bladder trauma to bowel injuries. Int Urol Nephrol. 2000;32(1):3–8.

    Article  CAS  PubMed  Google Scholar 

  • Dorairajan LN, Gupta H, Kumar S. Pelvic fracture-associated urethral injuries in girls: experience with primary repair. BJU Int. 2004;94(1):134–6.

    Article  PubMed  Google Scholar 

  • Duess JW, Schaller MC, Lacher M, Sorge I, Puri P, Gosemann JH. Accidental bladder injury during elective inguinal hernia repair: a preventable complication with high morbidity. Pediatr Surg Int. 2019; https://doi.org/10.1007/s00383-019-04554-6.

    Article  PubMed  Google Scholar 

  • Eassa W, El-Ghar MA, Jednak R, El-Sherbiny M. Nonoperative management of grade 5 renal injury in children: does it have a place? Eur Urol. 2010;57(1):154–61.

    Article  PubMed  Google Scholar 

  • Eeg KR, Khoury AE, Halachmi S, Braga LH, Farhat WA, Bägli DJ, Pippi Salle JL, Lorenzo AJ. Single center experience with application of the ALARA concept to serial imaging studies after blunt renal trauma in children – is ultrasound enough? J Urol. 2009;181(4):1834–40.

    Article  PubMed  Google Scholar 

  • Elgammal MA. Straddle injuries to the bulbar urethra: management and outcome in 53 patients. Int Braz J Urol. 2009;35(4):450–8.

    Article  PubMed  Google Scholar 

  • Elliott SP, McAninch JW. Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital. J Urol. 2003;170(4 Pt 1):1213–6.

    Article  PubMed  Google Scholar 

  • Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urol Clin North Am. 2006;33(1):55–66, vi.

    Article  PubMed  Google Scholar 

  • Fernández-Ibieta M. Renal trauma in pediatrics: a current review. Urology. 2018;113:171–8.

    Article  PubMed  Google Scholar 

  • Fitzgerald CL, Tran P, Burnell J, Broghammer JA, Santucci R. Instituting a conservative management protocol for pediatric blunt renal trauma: evaluation of a prospectively maintained patient registry. J Urol. 2011;185(3):1058–64.

    Article  PubMed  Google Scholar 

  • Glass AS, Bagga HS, Tasian GE, McGeady JB, McCulloch CE, Blaschko SD, McAninch JW, Breyer BN. No small slam: increasing incidents of genitourinary injury from toilets and toilet seats. BJU Int. 2013;112(3):398–403.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grimsby GM, Voelzke B, Hotaling J, Sorensen MD, Koyle M, Jacobs MA. Demographics of pediatric renal trauma. J Urol. 2014;192(5):1498–502.

    Article  PubMed  Google Scholar 

  • Hammer CC, Santucci RA. Effect of an institutional policy of nonoperative treatment of grades I to IV renal injuries. J Urol. 2003;169(5):1751–3.

    Article  PubMed  Google Scholar 

  • Helmy TE, Sarhan O, Hafez AT, Dawaba M, Ghoneim MA. Perineal anastomotic urethroplasty in a pediatric cohort with posterior urethral strictures: critical analysis of outcomes in a contemporary series. Urology. 2014;83(5):1145–8.

    Article  PubMed  Google Scholar 

  • Hemal AK, Dorairajan LN, Gupta NP. Posttraumatic complete and partial loss of urethra with pelvic fracture in girls: an appraisal of management. J Urol. 2000;163(1):282–7.

    Article  CAS  PubMed  Google Scholar 

  • Herschorn S, Thijssen A, Radomski SB. The value of immediate or early catheterization of the traumatized posterior urethra. J Urol. 1992;148:1428–31.

    Article  CAS  PubMed  Google Scholar 

  • Holland AJ, Cohen RC, McKertich KM, Cass DT. Urethral trauma in children. Pediatr Surg Int. 2001;17(1):58–61.

    Article  CAS  PubMed  Google Scholar 

  • Hong AR, Acuña MF, Peña A, Chaves L, Rodriguez G. Urologic injuries associated with repair of anorectal malformations in male patients. J Pediatr Surg. 2002;37(3):339–44.

    Article  PubMed  Google Scholar 

  • Huang CR, Sun N, Wei-Ping, Xie HW, Hwang AH, Hardy BE. The management of old urethral injury in young girls: analysis of 44 cases. J Pediatr Surg. 2003;38(9):1329–32.

    Article  PubMed  Google Scholar 

  • Ishii H, Griffin S, Somani BK. Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: results from a systematic review. J Pediatr Urol. 2014;10:1020–5. pii: S1477-5131(14)00234-4.

    Article  CAS  PubMed  Google Scholar 

  • Jacobs MA, Hotaling JM, Mueller BA, Koyle M, Rivara F, Voelzke BB. Conservative management vs early surgery for high grade pediatric renal trauma–do nephrectomy rates differ? J Urol. 2012;187(5):1817–22.

    Article  PubMed  PubMed Central  Google Scholar 

  • Khavari R, Bayne AP, Roth DR. A report of an iatrogenic bladder rupture in a normal healthy child during voiding cystourethrography. Urology. 2010;75(3):684–6.

    Article  PubMed  Google Scholar 

  • Kiankhooy A, Sartorelli KH, Vane DW, Bhave AD. Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children. J Trauma. 2010;68(3):526–31.

    Article  PubMed  Google Scholar 

  • Koraitim MM. Posttraumatic posterior urethral strictures in children: a 20-year experience. J Urol. 1997;157(2):641–5.

    Article  CAS  PubMed  Google Scholar 

  • Koraitim MM. Assessment and management of an open bladder neck at posterior urethroplasty. Urology. 2010;76(2):476–9.

    Article  PubMed  Google Scholar 

  • Koraitim MM, Marzouk ME, Atta MA, Orabi SS. Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol. 1996;77(6):876–80.

    Article  CAS  PubMed  Google Scholar 

  • Kotkin L, Koch MO. Morbidity associated with nonoperative management of extraperitoneal bladder injuries. J Trauma. 1995;38(6):895–8.

    Article  CAS  PubMed  Google Scholar 

  • Lautz T, Leonhardt D, Rowell E, Reynolds M. Intraperitoneal bladder rupture as an isolated manifestation of nonaccidental trauma in a child. Pediatr Emerg Care. 2009;25(4):260–2.

    Article  PubMed  Google Scholar 

  • Lawson CM, Daley BJ, Ormsby CB, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. 2011;70(2):452–6.

    Article  PubMed  Google Scholar 

  • Long JA, Manel A, Penillon S, Badet L, Sessa C, Descotes JL, Sengel C, Rambeaud JJ. Traumatic dissection of the renal pedicle. Modalities of management in adults and children. Prog Urol. 2004;14(3):302–9.

    PubMed  Google Scholar 

  • Maheshwari PN, Shah HN. Immediate endoscopic management of complete iatrogenic anterior urethral injuries: a case series with long-term results. BMC Urol. 2005;5:13.

    Article  PubMed  PubMed Central  Google Scholar 

  • McAleer IM, Kaplan GW, LoSasso BE. Congenital urinary tract anomalies in pediatric renal trauma patients. J Urol. 2002;168(4 Pt 2):1808–10; discussion 1810.

    Article  PubMed  Google Scholar 

  • McGahan JP, Richards JR, Jones CD, Gerscovich EO. Use of ultrasonography in the patient with acute renal trauma. J Ultrasound Med. 1999;18(3):207–13.

    Article  CAS  PubMed  Google Scholar 

  • Misra D, Chana J, Drake DP, Kiely EM, Spitz L. Operative trauma to the genitourinary tract in the treatment of anorectal malformations: 15 years’ experience. Urology. 1996;47(4):559–62.

    Article  CAS  PubMed  Google Scholar 

  • Morey AF, McAninch JW, Tiller BK, Duckett CP, Carroll PR. Single shot intraoperative excretory urography for the immediate evaluation of renal trauma. J Urol. 1999;161(4):1088–92.

    Article  CAS  PubMed  Google Scholar 

  • Mundy AR, Andrich DE. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management. BJU Int. 2010;105(9):1302–8.

    Article  PubMed  Google Scholar 

  • Orabi S. Transpubic posterior urethroplasty via perineal approach in children: a new technique. J Pediatr Urol. 2012;8(4):393–400.

    Article  PubMed  Google Scholar 

  • Orabi S, Badawy H, Saad A, Youssef M, Hanno A. Post-traumatic posterior urethral stricture in children: how to achieve a successful repair. J Pediatr Urol. 2008;4(4):290–4.

    Article  PubMed  Google Scholar 

  • Pippi Salle JL, Jesus LE, Lorenzo AJ, Romão RL, Figueroa VH, Bägli DJ, Reda E, Koyle MA, Farhat WA. Glans amputation during routine neonatal circumcision: mechanism of injury and strategy for prevention. J Pediatr Urol. 2013;9(6 Pt A):763–8.

    Article  PubMed  Google Scholar 

  • Podestá ML, Jordan GH. Pelvic fracture urethral injuries in girls. J Urol. 2001;165(5):1660–5.

    Article  PubMed  Google Scholar 

  • Pogorelić Z, Jurić I, Biočić M, Furlan D, Budimir D, Todorić J, Milunović KP. Management of testicular rupture after blunt trauma in children. Pediatr Surg Int. 2011;27(8):885–9. https://doi.org/10.1007/s00383-011-2873-9.

    Article  PubMed  Google Scholar 

  • Quinlan DM, Gearhart JP. Blunt renal trauma in childhood. Features indicating severe injury. Br J Urol. 1990;66(5):526–31.

    Article  CAS  PubMed  Google Scholar 

  • Riccabona M, Lobo ML, Papadopoulou F, Avni FE, Blickman JG, Dacher JN, Damasio B, Darge K, Ording-Müller LS, Vivier PH, Willi U. ESPR uroradiology task force and ESUR paediatric working group: imaging recommendations in paediatricuroradiology, part IV: minutes of the ESPR uroradiology task force mini-symposium on imaging in childhood renal hypertension and imaging of renal trauma in children. Pediatr Radiol. 2011;41(7):939–44.

    Article  PubMed  Google Scholar 

  • Rosenstein DI, Alsikafi NF. Diagnosis and classification of urethral injuries. Urol Clin North Am. 2006;33(1):73–85, vi-vii.

    Article  PubMed  Google Scholar 

  • Routh J, Husmann D. Long-term continence outcomes after immediate repair of pediatric bladder neck lacerations extending into the urethra. J Urol. 2007;178:1816–8.

    Article  PubMed  Google Scholar 

  • Routh JC, Tollefson MK, Ashley RA, Husmann DA. Iatrogenic ureteral injury: can adult repair techniques be used on children? J Pediatr Urol. 2009;5(1):53–5.

    Article  PubMed  Google Scholar 

  • Santucci RA, McAninch JW, Safir M, Mario LA, Service S, Segal MR. Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma. 2001;50(2):195–200.

    Article  CAS  PubMed  Google Scholar 

  • Santucci RA, Langenburg SE, Zachareas MJ. Traumatic hematuria in children can be evaluated as in adults. J Urol. 2004a;171(2 Pt 1):822–5.

    Article  PubMed  Google Scholar 

  • Santucci RA, Wessells H, Bartsch G, Desctes J, Heyns CF, McAninch JW, Nash P, Schmidlin F. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int. 2004b;93(7):937–54.

    Article  CAS  PubMed  Google Scholar 

  • Saxena AK, Steiner M, Höllwarth ME. Straddle injuries in female children and adolescents: 10-year accident and management analysis. Indian J Pediatr. 2014;81(8):766–9.

    Article  PubMed  Google Scholar 

  • Shariat SF, Jenkins A, Roehrborn CG, Karam JA, Stage KH, Karakiewicz PI. Features and outcomes of patients with grade IV renal injury. BJU Int. 2008;102(6):728–33.

    Article  PubMed  Google Scholar 

  • Shenfeld OZ, Gofrin ON, Gdor Y, Landau EH, Pode D. A anastomotic urethroplasty for failed previously treated posterior urethral rupture. Urology. 2004;63(5):837–40.

    Article  PubMed  Google Scholar 

  • Shenfeld OZ, Gdor J, Katz R, Gofrit ON, Pode D, Landau EH. Urethroplasty, by perineal approach, for bulbar and membranous urethral strictures in children and adolescents. Urology. 2008;71(3):430–3.

    Article  PubMed  Google Scholar 

  • Shlamovitz GZ, Mower WR, Bergman J, Crist J, DeVore HK, Hardy D, Sargent M, Shroff SD, Snyder E, Morgan MT. Lack of evidence to support routine digital rectal examination in pediatric trauma patients. Pediatr Emerg Care. 2007;23(8):537–43.

    Article  PubMed  Google Scholar 

  • Silber JS, Flynn JN, Koffler KM, Dormans JPEG, Drummond DS. Analysis of the cause, classification ans associated injuries of 166 consecutive pediatric pelvic fractures. J Pediatr Orthop. 2001;21(4):446–50.

    CAS  PubMed  Google Scholar 

  • Singh BP, Andankar MG, Swain SK, Das K, Dassi V, Kaswan HK, Agrawal V, Pathak HR. Impact of prior urethral manipulation on outcome of anastomotic urethroplasty for post traumatic urethral stricture. Urology. 2010;75(1):179–82.

    Article  PubMed  Google Scholar 

  • Sofer M, Mabjeesh NJ, Ben-Chaim J, Aviram G, Bar-Yosef Y, Matzkin H, Kaver I. Long term results of endoscopic realignment of complete posterior urethral disruption. J Endourol. 2010;24(7):1117–21.

    Article  PubMed  Google Scholar 

  • Summerton DJ (chair), Djakovic N, Kitrey ND, Kuehhas FE, Lumen N, Serafetinidis E, Sharma DM. Guidelines on urological trauma. EAU Guidelines 2014.

    Google Scholar 

  • Tarman GJ, Kaplan GW, Lerman SL, McAleer IM, Losasso BE. Lower genitourinary injury and pelvic fractures in pediatric patients. Urology. 2002;159(1):123–6.

    Article  Google Scholar 

  • Umbreit EC, Routh JC, Husmann DA. Nonoperative management of nonvascular grade IV blunt renal trauma in children: meta-analysis and systematic review. Urology. 2009;74(3):579–82.

    Article  PubMed  Google Scholar 

  • Upadhyaya M, Freeman NV. Management of traumatic urethral disruption in children: Oman experience, 1988–2000. J Pediatr Surg. 2002;37(10):1451–5.

    Article  PubMed  Google Scholar 

  • Webster GD, Mathes GL, Selli C. Prostate membranous urethral injuries: a review of the literature and a rational approach to their management. J Urol. 1983;130(5):898–902.

    Article  CAS  PubMed  Google Scholar 

  • Wirth GJ, Peter R, Poletti PA, Iselin CE. Advances in the management of blunt traumatic bladder rupture: experience with 36 cases. BJU Int. 2010;106(9):1344–9.

    Article  PubMed  Google Scholar 

  • Wong KY, Jeeneea R, Healey A, Abernethy L, Corbett HJ, McAndrew HF, Losty PD. Management of paediatric high-grade blunt renal trauma: a 10-year single-centre UK experience. BJU Int. 2018;121(6):923–7.

    Article  PubMed  Google Scholar 

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Correspondence to Ofer Z. Shenfeld .

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Shenfeld, O.Z., Chertin, B. (2020). Pediatric Genitourinary Trauma. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_126-1

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