Pediatric emergency medicine trisk 3308 3308
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CHAPTER 108 ■ GENITOURINARY TRAUMA
R. CALEB KOVELL, GREGORY E. TASIAN, ROBERT A. BELFER
INTRODUCTION
Genitourinary trauma in children is common with approximately 28,000 children
presenting to emergency departments (EDs) in the United States annually with
genitourinary injuries. Approximately 10% of patients with serious multisystem
trauma have genitourinary injuries and 3% of pediatric patients admitted with
trauma will have a genitourinary injury. Most injuries (90%) are the result of
blunt trauma that involves crush injury and acceleration/deceleration forces
related to motor vehicle collisions, and falls of high-velocity injuries such as
sledding, skateboarding, or skiing.
The clinical approach to the injured child follows advanced trauma life support
guidelines. Figure 108.1 provides an algorithm for diagnostic evaluation of
pediatric patients with genitourinary trauma. Management of genitourinary
injuries in the emergency setting generally involves fully identifying the location
and extent of the injury, prevention of ongoing injury by establishing urinary
drainage and planning for operative procedures, when necessary.
KEY POINTS
The goal of emergency therapy for genitourinary injury is to maximize
organ preservation and minimize future morbidity.
Assessment of the genitourinary system can be undertaken once lifethreatening conditions have been identified and the child has been
resuscitated.
Management of hemodynamically stable children with renal injuries
should proceed on the basis of radiographic staging of the traumatic
injury.
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