Pediatric Genitourinary Trauma

  • Ofer Z. ShenfeldEmail author
  • Boris Chertin
Living reference work entry


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.


Renal trauma Children Blunt abdominal trauma Bladder injury Ureteral injury Conservative treatment 


  1. Abdalla MA. A posterior sagittal pararectal approach for repair of posterior urethral distraction injuries. Eur Urol. 2008;53(1):191–6.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  3. Andrich DE, Mundy AR. The nature of urethral injury in cases of pelvic fracture urethral trauma. J Urol. 2001;165(5):1492–5.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 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.PubMedPubMedCentralGoogle Scholar
  11. Buckley JC, McAninch JW. Pediatric renal injuries: management guidelines from a 25-year experience. J Urol. 2004;172(2):687–90.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  13. Chopra P, St-Vil D, Yazbeck S. Blunt renal trauma-blessing in disguise? J Pediatr Surg. 2002;37(5):779–82.PubMedCrossRefPubMedCentralGoogle Scholar
  14. Dalton BGA, Dehmer JJ, Shah SR. Blunt renal trauma. J Pediatr Intensive Care. 2015;4(1):16–20.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  18. Dorairajan LN, Gupta H, Kumar S. Pelvic fracture-associated urethral injuries in girls: experience with primary repair. BJU Int. 2004;94(1):134–6.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 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; Scholar
  20. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  22. Elgammal MA. Straddle injuries to the bulbar urethra: management and outcome in 53 patients. Int Braz J Urol. 2009;35(4):450–8.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  24. Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urol Clin North Am. 2006;33(1):55–66, vi.PubMedCrossRefPubMedCentralGoogle Scholar
  25. Fernández-Ibieta M. Renal trauma in pediatrics: a current review. Urology. 2018;113:171–8.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  28. Grimsby GM, Voelzke B, Hotaling J, Sorensen MD, Koyle M, Jacobs MA. Demographics of pediatric renal trauma. J Urol. 2014;192(5):1498–502.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  32. Herschorn S, Thijssen A, Radomski SB. The value of immediate or early catheterization of the traumatized posterior urethra. J Urol. 1992;148:1428–31.PubMedCrossRefPubMedCentralGoogle Scholar
  33. Holland AJ, Cohen RC, McKertich KM, Cass DT. Urethral trauma in children. Pediatr Surg Int. 2001;17(1):58–61.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  40. Koraitim MM. Posttraumatic posterior urethral strictures in children: a 20-year experience. J Urol. 1997;157(2):641–5.PubMedCrossRefPubMedCentralGoogle Scholar
  41. Koraitim MM. Assessment and management of an open bladder neck at posterior urethroplasty. Urology. 2010;76(2):476–9.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  43. Kotkin L, Koch MO. Morbidity associated with nonoperative management of extraperitoneal bladder injuries. J Trauma. 1995;38(6):895–8.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  45. Lawson CM, Daley BJ, Ormsby CB, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. 2011;70(2):452–6.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 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.PubMedPubMedCentralGoogle Scholar
  47. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  53. Orabi S. Transpubic posterior urethroplasty via perineal approach in children: a new technique. J Pediatr Urol. 2012;8(4):393–400.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  56. Podestá ML, Jordan GH. Pelvic fracture urethral injuries in girls. J Urol. 2001;165(5):1660–5.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 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. Scholar
  58. Quinlan DM, Gearhart JP. Blunt renal trauma in childhood. Features indicating severe injury. Br J Urol. 1990;66(5):526–31.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  60. Rosenstein DI, Alsikafi NF. Diagnosis and classification of urethral injuries. Urol Clin North Am. 2006;33(1):73–85, vi-vii.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 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.PubMedPubMedCentralGoogle Scholar
  72. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  74. Summerton DJ (chair), Djakovic N, Kitrey ND, Kuehhas FE, Lumen N, Serafetinidis E, Sharma DM. Guidelines on urological trauma. EAU Guidelines 2014.Google Scholar
  75. 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.CrossRefGoogle Scholar
  76. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  77. Upadhyaya M, Freeman NV. Management of traumatic urethral disruption in children: Oman experience, 1988–2000. J Pediatr Surg. 2002;37(10):1451–5.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 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.PubMedCrossRefPubMedCentralGoogle Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Urology, Shaare Zedek Medical Center, Faculty of Medical ScienceHebrew UniversityJerusalemIsrael
  2. 2.Department of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical ScienceHebrew UniversityJerusalemIsrael

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