Lower genitourinary injury and pelvic fractures in pediatric patients

Abstract

Objectives. To report the largest series of pelvic fracture and lower genitourinary tract injury in the pediatric population to further define its incidence. The association between pelvic fractures and lower genitourinary tract injury has been well recognized in the adult population. The incidence of bladder or urethral injury is approximately 10% to 15%. Previous limited pediatric reviews placed its incidence at slightly lower levels. Methods. A retrospective review of 8021 trauma patients presenting between July 1992 and March 1999 to a pediatric trauma center included 212 consecutive patients with pelvic fractures. These records were reviewed to determine the incidence of genitourinary injury in children with pelvic fractures. Thirty-six patients were identified with a genitourinary injury, and their records were analyzed. Results. Thirty-six patients (17%) were identified to have sustained a genitourinary injury out of the study cohort of 212 patients with pelvic fractures when patients with isolated hematuria were included. Hematuria was noted in 30 patients (14.2%). Fourteen (6.6%) had gross hematuria. Only 2 (0.9%) of the 212 patients had a significant lower urinary tract injury (one extraperitoneal bladder rupture and one posterior urethral disruption); both had gross hematuria. Genital injuries were seen in 4 other patients (1.9%). Lower genitourinary injury occurred in a total of 6 (2.8%) of the 212 patients with pelvic fractures. Conclusions. The incidence of significant lower genitourinary injury in pediatric patients with pelvic fractures is lower than that reported in previous adult and pediatric reviews. Significant lower genitourinary injuries were not found in stable patients without gross hematuria or multiple associated injuries and with a normal genitourinary examination.