Abstract

Objective: Patients who suffered from blunt trauma to the genitourinary system (GUS) were evaluated retrospectively for factors related to renal trauma (RT).

Material and Methods: Information (age, gender, type and severity of trauma, presence of additional organ injury, follow-up and treatment data) of patients who had experienced GUS trauma between February 2010 and July 2012 were collected from the patient charts. Grade 4 and 5 RT’s were recorded as severe according to the trauma organ severity scale and RT’s above grade 2 were investigated using DMSA scintigraphy.

Results: A total of 34 patients consisting of 21 males and 13 females (mean age 8.82) were reviewed. There were 22 cases of RT and 12 cases of extrarenal GUS trauma. There were also 11 Vehicle out Traffi c Accidents (VOTA), 4 Vehicle in Traffi c Accidents (VITA), 17 Falling from Height (FFH), and 2 explosion injury cases were detected. Grade 1 and 2 RT’s were most common but 4 patients (18%) had grade 4 and 5 RT. Hematuria was present in 13 renal and 12 extrarenal cases. The RT was isolated in 7 and together with additional organ injury in 15 cases. The location was the right side in 15 and the left side in 7 RT cases. There were 8 patients who had grade 2 and higher grades of injury and renal scintigraphy revealed decreased function in 4 of these children. A JJ stent was inserted for an expanding perirenal collection in 2 patients. Surgery was required for 9 patients who had exrarenal trauma. The rates of hematuria and surgery were higher in the extrarenal trauma group. The RT rate was low and the extrarenal GUS trauma rate high in the VOTA group while the opposite was true in the VITA and FFH groups. Hospitalization time, hematuria, need for surgery, scintigraphy results revealing decreased renal function, and left RT rates were signifi cantly higher in the severe RT group compared with the non-severe RT group. Scintigraphy results revealing decreased renal function rates were also more common in left RT cases when compared with right RT cases. There was no difference in terms of other parameters.

Conclusion: RT rates are higher in children with FFH and VITA so appropriate studies are required

Keywords: Trauma, Urogenital system

References

  1. Koltuksuz U, Gürsoy MH. Çocuklarda genitoüriner travmalar. Turgut Özal Tıp Merkezi Dergisi 1998;5:97-104.
  2. McAleer IM, Kaplan GW, Sherz HC, Packer MG, Lynch FP. Genitourinary trauma in the pediatric patient. Urology 1993;42:563- 8.
  3. Brown SL, Elder JS, Spirnak JP. Are pediatric patients more susceptible to major renal injury from blunt trauma? A comparative study. J Urol 1998;160:138-40.
  4. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: Spleen, liver, and kidney. J Trauma 1989;29:1664-6.
  5. Casale AJ. Genitourinary Trauma in Children, Urologic Surgery Infants and Children, In: King LR (ed), Philedelphial Saunders, 1997: 264.
  6. McAleer IM, Kaplan GW: Pediatric genitourinary trauma. Urol Clin North Am 1995; 22:177-88.
  7. Radmayr C, Oswald J, Müller E, Höltl L, Bartsch G. Blunt renal trauma in children: 26 years clinical experience in an alpine region. Eur Urol 2002;42:297-300.
  8. He B, Lin T, Wei G, He D, Li X. Management of blunt renal trauma: An experience in 84 children. Int Urol Nephrol 2011;43:937-42.
  9. Rogers CG, Knight V, MacUra KJ, Ziegfeld S, Paidas CN, Mathews RI. High-grade renal injuries in children-Is conservative management possible? Urology 2004;64:574-9.
  10. Henderson CG, Sedberry-Ross S, Pickard R, Bulas DI, Duffy BJ, Tsung D, et al. Management of high grade renal trauma: 20-year experience at a pediatric level I trauma center. J Urol 2007;178: 246-50.
  11. Sharp DS, Ross JH, Kay R. Attitudes of pediatric urologists regarding sports participation in children with a solitary kidney. J Urol 2002;168:1811-4.
  12. Hashmi A, Klassen T. Correlation between urinalysis and intravenous pyelography in pediatric abdominal trauma. J Emerg Med 1995;13:255-8.
  13. Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg 2006;244:620-8.
  14. Keller MS, Eric Coln C, Garza JJ, Sartorelli KH, Christine Green M, Weber TR. Functional outcome of nonoperatively managed renal injuries in children. J Trauma 2004;57:108-10.
  15. Bozeman C, Carver B, Zabari G, Caldito G, Venable D. Selective operative management of major blunt renal trauma. J Trauma 2004;57:305-9.
  16. Yang CS, Chen IC, Wang CY, Liu CC, Shih HC, Huang MS. Predictive indications of operation and mortality following renal trauma. J Chin Med Assoc 2012;75:21-4.
  17. Nance ML, Lutz N, Carr MC, Canning DA, Stafford PW. Blunt renal injuries in children can be managed nonoperatively: Outcome in a consecutive series of patients. J Trauma 2004;57:474-8.
  18. Baumann L, Greenfi eld SP, Aker J, Brody A, Karp M, Allen J, et al. Nonoperative management of major blunt renal trauma in children: In-hospital morbidity and long-term followup. J Urol 1992;148: 691-3.
  19. Philpott JM, Nance ML, Carr MC, Canning DA, Stafford PW. Ureteral stenting in the management of urinoma after severe blunt renal trauma in children. J Pediatr Surg 2003;38:1096-8.
  20. Netter FH. Anatomy structure and embryology. In: The Netter Collection of Medical Illustrations, Volume 6, Pittsburg, Pa: Kidneys Ureters and Urinary Bladder, Novartis Publication, 1997:1-35.

Copyright and license

How to cite

1.
Karabulut B, Özcan F, Azılı MN, Şenaylı A, Akbıyık F, Mambet E, et al. Genitourinary System Trauma in Children. Turk J Pediatr Dis [Internet]. 2014 Apr. 1 [cited 2025 May 24];8(4):186-91. Available from: https://turkjpediatrdis.org/article/view/292