Genitourinary Injuries Research Articles

EDITORIAL COMMENT ON “The Epidemiology of Genitourinary Self-Inflicted Injuries: Analysis of the National Trauma Databank”

EDITORIAL COMMENT ON “The Epidemiology of Genitourinary Self-Inflicted Injuries: Analysis of the National Trauma Databank”

The Epidemiology of Genitourinary Self-inflicted Injuries: Analysis of the National Trauma Databank

ObjectivesTo provide insight into the epidemiologic characteristics and trends of genitourinary (GU) self-inflicted injury (SII). MethodsWe used data from the National Trauma Databank between 2017-2020. We described the characteristics of GU SII cases based on injured organ and then compared male and female injuries. ResultsWe identified 56,463 patients with SII, of which 1,508 (2.7%) had GU involvement. Most cases were male patients (77.3%) and white (70.6%). Median age was 35 years (IQR 26 – 50). The most commonly injured GU organs was kidney (43.4%), followed by scrotum / testes (22.5%), and penis (18.2%). Most cases (89.9%) represented a single-organ injury whereas 10.1% had two or more GU organs injured. Seventy-three of those with kidney injuries (11.2%) underwent nephrectomy. Only one patient performing GU SII had a diagnosis code for transsexualism but the majority (82.2%) suffered from pre-existing conditions of which 20.5% had three or more comorbidities. More than half the population (54.9%) had preexisting diagnosed mental or personality disorder. A non-GU co-injury was present in most cases (70.8%), most commonly affecting another abdominal organ (44.3%) or fractures (41.3%). A positive drug screen was found in 30.7% of cases. Most patients survived though 15.4% died. 94% of fatal cases had a concomitant non-GU injury. ConclusionsGU injuries account for 2.6% of all SII. These patients are often young white males with known mental or personality disorders. Kidneys were most common injuried and mortality was highest in cases of kidney and bladder injuries with multi-organ trauma involving non-GU organs.

Urologic Trauma Management for Military Providers.

Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

Legal Outcomes of Litigation After Iatrogenic Genitourinary Trauma

INTRODUCTIONTo evaluate plaintiff and defendant characteristics associated with iatrogenic genitourinary trauma litigation and outcomes of closed claims. METHODSLexisNexis was queried in April 2023 using terms related to genitourinary organs and injury, and manually reviewed for iatrogenic cases. Case details including defendant, organ involvement, and legal outcome were obtained. Multinomial regression analysis was performed to identify factors associated with outcome. RESULTS410 cases involving 611 defendants were identified, with the ureter the most commonly affected organ (202/410, 49.3%). Most cases involved adult plaintiffs (380, 92.7%) and resulted in favor of the defense (227, 55.4%). Injuries resulted most frequently from gynecologic surgeries (179, 43.7%). Defendants were most commonly obstetricians/gynecologists (243/611, 39.8%) and urologists (168, 27.5%). Penile (OR 6.3 [95% CI 2.5-16.1]) and urethral (OR 4.8 [2.0-11.7]) injuries were associated with greater odds of a plaintiff verdict relative to ureter injury. A plaintiff verdict was also more likely when defendants were academic hospitals compared to individual practitioners (OR 4.3 [1.9-9.9]). In cases ruling in favor of the plaintiff, indemnity payments were larger when the defendants were comprised of individual practitioners compared to a hospital or medical group (median $549,613 vs. $250,000, p < 0.001). CONCLUSIONUrologists may be involved in medical malpractice lawsuits for iatrogenic injury even when they are uninvolved in the index procedure. Most cases that reach litigation result in defense verdicts regardless of the genitourinary organ injured. Defendant characteristics associated with plaintiff verdicts are more nuanced, and providers should be aware of potential downstream effects of litigation.

Liar, liar, Pants on Fire’ – Management of Genitorinary Injury Sustained post ‘Cherry Bomb’ Explosion

Penile trauma comprised of 10-16% of genitourinary injury based on several single institution series [1]. Penetrating external genitalia trauma was 0.57%, of all trauma. 28% of it, was penile injuries, with concomitant urethra injuries occurred in 13% [2]. In ballistic injury, the penetrating wound could be superficial, however misleading and underrepresented of the actual extent of injury. Principle of treatment: immediate exploration, copious irrigation, excision of foreign matter, antibiotic prophylaxis and surgical closure [3]. The functional outcomes were excellent [4]. A case of 29 years old male with penetrating penile trauma with concomitant urethral trauma.

Gunshot wound injury to the genitourinary tract: a 4-year retrospective review at an academic level 1 trauma center.

Firearm injuries increased significantly during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to describe our experience with patients admitted to a level 1 trauma center with gunshot-related trauma to the genitourinary (GU) tract before and during COVID-19 pandemic. Patients sustaining gunshot-related trauma to the adrenals, kidneys, ureters, bladder, scrotum, testicles, penis, and urethra between January 1, 2018 and December 31, 2021 were identified from our institutional trauma database. Patient charts were queried to extract demographic information, management, and follow-up. A total of 117 patients met inclusion criteria with 39 (33%) of GU injuries occurring pre-COVID, and 78 (67%) occurring during or post-COVID. Seventy-two (62%) presented with kidney injury. Patients injured in the pre-COVID period were more likely to participate in a follow-up visit by 2.17 times at 60 days (P=0.017), 1.98 times at 90 days (P=0.030), and 2.04 times at 1-year (P=0.014) than during COVID. Pre-COVID, 46% of patients were injured in the city's northwestern region and 54% from other areas, during COVID 24% of patients came from the northwestern region compared to 76% from other areas (P=0.029). Gunshot wounds (GSW) involving the GU tract increased during the COVID-19 pandemic, with renal injury most frequent. Follow-up visits declined by around half during the pandemic, primarily at 60 days, 90 days, and 1 year post-injury. The number of patients admitted with urologic injuries pre-COVID versus during COVID was significantly different depending on the patient's area of residence. More work is needed to evaluate the outcomes of traumatic GU injuries due to GSW pre- and post-pandemic.

Relationship between patient safety indicator events and hospital location for inpatient hysterectomy.

Previous studies suggest surgical quality outcomes are similar between rural and urban hospitals, but data about gynecology in rural hospitals is sparse. This was a retrospective cohort study utilizing the National Inpatient Sample database from the Agency of Healthcare Research and Quality. Patients who underwent benign hysterectomy for non-prolapse indications between 2012-2016 were identified using ICD-9 and 10 codes. Patients were stratified into rural or urban non-teaching groups; urban teaching hospitals were the referent group. The primary outcome was the rate of patient safety indicator (PSI) events. PSI events were identified using ICD-9 and 10 codes. Statistical analysis was performed using analysis of variance and uni- and multivariate Poisson regressions. 154,810 patients met all inclusion criteria. The cumulative rate of PSI events was 11.9% at rural hospitals, 13.9% at urban non-teaching hospitals and 16.9% at urban teaching hospitals, P<0.001. The most common PSI events were postoperative metabolic derangement, hemorrhage, and accidental puncture. The rate of transfusion was highest in urban teaching hospitals (6.7%) and similar for rural (5.1%) and urban non-teaching hospitals (5.5%), P<0.001. The rate of genitourinary tract injury was between 1.4-1.6%, and similar across sites, P=0.89. After adjusting for confounders, the risk of PSI events was similar across locations. The risk of transfusion was lower at rural hospitals (aRR=0.84, 95% CI: 0.74-0.94). Hysterectomy performed at rural hospitals, typically thought of as having low surgical volume compared to urban hospitals, is associated with similar risk of PSI events and lower risk of transfusion.

A Narrative Review of Contact Sports Participation in Children and Young Athletes With a Solitary (Functioning) Kidney

Background: Evidence is sparse regarding the incidence or prevalence of renal or genitourinary injuries arising from contact sports. There are currently no World Health Organization or European consensus guidelines relating to the participation in sport for children and young athletes with a solitary (functioning) kidney. Purpose: To review the international literature and to make sport-specific recommendations for children and young athletes with a solitary (functioning) kidney participating in sports, based on the overall likelihood of potential renal or genitourinary injury. Study Design: Narrative review; Level of evidence, 4. Methods: A descriptive epidemiological study was conducted of current literature according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Embase, Google Scholar, Cochrane, and PubMed databases were queried from 1975 to 2023, to assess available evidence regarding the prevalence and risk of renal injury through sports participation and guidelines surrounding the participation in sports for children and young athletes with a solitary (functioning) kidney. Methodological quality and certainty of evidence were assessed according to the International Classification of Urological Disease guidelines. Results: A total of 28 publications were identified after database searches and exclusions, comprising 40,889 patients. The majority of papers providing recommendations arose from the United States. Of the recommendations, 79% permitted an unrestricted return to noncontact sports. A return to contact sports is permitted in most instances after physician consultation. Conclusion: There is a dearth of good-quality published evidence in the literature relating to sports participation with a solitary (functioning) kidney. Overall, the risk of genitourinary injury in sports is low, and after physician assessment, there is currently no strong evidence to exclude children and young athletes with a solitary (functioning) kidney from full participation in contact and collision sports.

Prepubic urethral transposition, with prostatic urethral anastomosis to penile urethra, after severe membrane urethral injury in dog - case report

Rupture of the membranous urethra caused by automobile trauma in dogs, accounting for only 5% of genitourinary tract injuries. The higher prevalence in male dogs is noteworthy due to pelvic anatomy and locomotion habits. Clinical signs include edema, anuria, hematuria, pain, and uroperitoneum, requiring an emergency approach. Diagnosis is usually based on history and imaging tests such as ultrasonography and urethrocystography. Treatment varies based on the location of the injury, with surgical intervention being crucial in complete tears. Prepubic urethral transposition with terminal anastomosis from the prostatic urethra to the penile urethra, although little used in veterinary medicine, presents benefits in male dogs, providing a new urinary path without significant aesthetic changes. The case report presents the successful application of this technique in a canine patient with rupture of the membranous urethra due to automobile trauma, aiming to establish an efficient urinary flow without complications and without compromising genital aesthetics.

Single-cell RNA-seq analysis decodes the kidney microenvironment induced by polystyrene microplastics in mice receiving a high-fat diet

In recent years, the environmental health issue of microplastics has aroused an increasingly significant concern. Some studies suggested that exposure to polystyrene microplastics (PS-MPs) may lead to renal inflammation and oxidative stress in animals. However, little is known about the essential effects of PS-MPs with high-fat diet (HFD) on renal development and microenvironment. In this study, we provided the single-cell transcriptomic landscape of the kidney microenvironment induced by PS-MPs and HFD in mouse models by unbiased single-cell RNA sequencing (scRNA-seq). The kidney injury cell atlases in mice were evaluated after continued PS-MPs exposure, or HFD treated for 35 days. Results showed that PS-MPs plus HFD treatment aggravated the kidney injury and profibrotic microenvironment, reshaping mouse kidney cellular components. First, we found that PS-MPs plus HFD treatment acted on extracellular matrix organization of renal epithelial cells, specifically the proximal and distal convoluted tubule cells, to inhibit renal development and induce ROS-driven carcinogenesis. Second, PS-MPs plus HFD treatment induced activated PI3K-Akt, MAPK, and IL-17 signaling pathways in endothelial cells. Besides, PS-MPs plus HFD treatment markedly increased the proportions of CD8+ effector T cells and proliferating T cells. Notably, mononuclear phagocytes exhibited substantial remodeling and enriched in oxidative phosphorylation and chemical carcinogenesis pathways after PS-MPs plus HFD treatment, typified by alterations tissue-resident M2-like PF4+ macrophages. Multispectral immunofluorescence and immunohistochemistry identified PF4+ macrophages in clear cell renal cell carcinoma (ccRCC) and adjacent normal tissues, indicating that activate PF4+ macrophages might regulate the profibrotic and pro-tumorigenic microenvironment after renal injury. In conclusion, this study first systematically revealed molecular variation of renal cells and immune cells in mice kidney microenvironment induced by PS-MPs and HFD with the scRNA-seq approach, which provided a molecular basis for decoding the effects of PS-MPs on genitourinary injury and understanding their potential profibrotic and carcinogenesis in mammals.Graphical

Predicting Genitourinary Injuries in Polytraumatized Patients—Development of the GUIPP Scoring System

Background: The genitourinary system is not as commonly affected as many other organ systems in severely injured patients. Although a delayed and missed diagnosis of genitourinary injuries (GUIs) can severely compromise long-term outcomes, these injuries are frequently overlooked. Therefore, we present a scoring system designed to assist emergency physicians in diagnosing GUIs in severely injured patients. Methods: The data were obtained from the TraumaRegister DGU® from the years 2015–2021. All severely injured patients (ISS ≥ 16) ≥16 years of age and treated in Germany, Austria, or Switzerland were included in this study. We excluded patients who were transferred out early (48 h), and all patients with isolated traumatic brain injury. After the univariate analysis of the relevant predictive factors, we developed a scoring system using a binary logistic regression model. Results: A total of 70,467 patients were included in this study, of which 4760 (6.8%) sustained a GUI. Male patients (OR: 1.31, 95% CI [1.22, 1.41]) injured in motorcycle accidents (OR: 1.70, 95% CI [1.55, 1.87]), who were under 60 years of age (OR: 1.59, 95% CI [1.49, 1.71]) and had sustained injuries in multiple body regions (OR: 6.63, 95% CI [5.88, 7.47]), and suffered severe pelvic girdle injuries (OR: 2.58, 95% CI [2.29, 2.91]) had the highest odds of sustaining a GUI. With these predictive factors combined, a novel scoring system, the GUIPP score, was developed. It showed good validity, with an AUC of 0.722 (95% CI [0.71; 0.73]). Conclusion: Predicting GUI in severely injured patients remains a challenge for treating physicians, but is extremely important to prevent poor outcomes for affected patients. The GUIPP score can be utilized to initiate appropriate diagnostic steps early on in order to reduce the delayed and missed diagnosis of GUI, with scores ≥ 9 points making GUIs very likely.

Impact of Prostate Cancer-related Genitourinary Radiation Injury on Mental Health Diagnosis and Treatment: Assessment of 55,425 Men

To investigate the association of low-grade radiation injury (LGRI) and high-grade radiation injury (HGRI) following prostate cancer treatment with mental health diagnoses and therapy. A retrospective study of men diagnosed with prostate cancer who were treated with radiotherapy. Men were followed to assess for LGRI or HGRI using IBM MarketScan. Cohorts included: no injury (no-RI), LGRI, HGRI, and controls. Mental health diagnoses and related treatment (medication/therapy) were identified using ICD-10 codes, CPT codes, and national drug codes. A multivariable Cox proportional hazards model from time of radiation to first instance of mental health diagnosis was modeled against injury group, age, and comorbidities. Between 2011-2020 we identified 55,425 men who received radiotherapy for prostate cancer. 22,879 (41.3%) experienced a LGRI while 4,128 (7.4%) experienced a HGRI. Prior to radiation therapy, mental health diagnoses were equally distributed across cohorts (p>0.05). Every marker of mental health showed a step-wise increase in incidence from no-RI to LGRI to HGRI except for alcohol abuse. Use of mental health medications and therapy visits were slightly more likely in the LGRI and HGRI groups prior to radiation, however this difference was greatly increased post-radiation therapy. LGRI (HR 1.38; p<0.001) and HGRI (HR 2.1;p<0.001) were independently associated with an increased likelihood of mental health diagnoses. LGRI and HGRI following prostate cancer radiotherapy are associated with increased risk of mental health diagnosis, medication use, and therapy need compared to men who do not develop injuries. The most common mental health diagnoses were depression and anxiety.

Pediatric genitourinary injuries: 7-year experience at the largest tertiary referral hospital in Eastern part of Indonesia

The anatomical variations between children and adults render pediatric patients more prone to urogenital trauma. However, it is not known for certain whether children are more prone to genitourinary trauma than adults. The aim of the study is to scrutinize the characteristic of pediatric genitourinary trauma at, the largest tertiary hospital in Eastern part of Indonesia. The design of the study was analytic retrospective gathering medical records of all pediatric patients with urogenital trauma with total sampling. The number of patients, ages, genders, etiology, locations, and management were collected. Data was statistically analyzed using SPSS®, and p<0.05 was considered statistically significant. We found 13.5 (10-15.5) years as the median age in our 60 samples. Boy (75.00%), renal trauma (56.67%), abdominal and pelvic trauma (96.67%), traffic accident (91.67%), suprapubic catheterization (52.17%), and hemodynamically stable (91.67) was among the majority. We also found that non-operative management was in majority. Statistical analysis demonstrated significant differences for management and grade of injury (p<0.05). This is, to the best of our knowledge, the first study of genitourinary injuries in children who were treated at a tertiary hospital in Indonesia during the course of the 7-year research period. The limitations of this study are retrospective character and conducted in single institution. The highest incidence of pediatric urogenital trauma is renal trauma due to traffic accident, which often multitrauma. Future prospective multi-center studies should be done to corroborate the results.

Ultrasound-guided extracorporeal shock wave lithotripsy with minimal x-ray exposure prevented genitourinary tract injury patients with urolithiasis in Taiwan.

This study investigated the use of ultrasound-guided extracorporeal shock wave lithotripsy (ESWL) to break stones in the genitourinary tract and prevent genitourinary injury. Our goals were to achieve accurate focusing and minimal X-ray exposure for the benefit of the patients. The LiteMed LM-9200 lithotripter with ultrasonography and fluoroscopy was used for two different procedures: autoaimed and autoperiodical. These procedures enabled dual focusing on stone localization and tracking. Out of 108 patients who underwent autoperiodical procedures, 29 had no gross hematuria. Among the 335 patients who received autoaimed procedures, 194 had no gross hematuria. The average duration of X-ray exposure during autoperiodical and autoaimed procedures was 120 and 50 s, respectively. The ultrasound-guided ESWL with minimal X-ray exposure was found to be useful in treating genitourinary upper-tract urolithiasis in the autoaimed procedure. Patients who underwent the autoaimed procedure experienced less gross hematuria compared to those who underwent the autoperiodical procedure.

Urology during Afghanistan mission: lessons learned and implications for the future

PurposeBattle-related trauma is common in modern warfare and can lead to genitourinary injuries. In Western countries, urogenital injuries are rare in the civilian environment. The main objective of this study was to assess urological workload for surgeons on deployment.Material and methodsData were acquired over a period of five years of deployment in a U.S. facility in Afghanistan.ResultsGerman urological surgeons treated on average one urologic outpatient per day and performed 314 surgical interventions overall. Surgical interventions were categorized as battle-related interventions (BRIs, n = 169, 53.8%) and nonbattle-related interventions (non-BRIs, n = 145, 46.2%). In the BRI group, interventions were mainly performed on the external genitalia (n = 67, 39.6%), while in the non-BRI group, endourological procedures predominated (n = 109). This is consistent with a higher rate of abdominal or pelvic procedures performed in the BRI group (n = 51, 30.2%).Furthermore, the types of interventions performed on the external genitalia differed significantly. In the BRI group, 58.2% (n = 39) of interventions were scrotal explorations, but none of those procedures were performed in the non-BRI group (p < 0.001). However, 50.0% (n = 13) of scrotal explorations in the non-BRI group were due to suspected torsions of the testes followed by orchidopexy (BRI: n = 1, 1.5%, p < 0.001). Concerning outpatients, the consultation was mainly due to complaints concerning the external genitalia (32.7%, n = 252) or kidney/ureteral stones (23.5%, n = 181).ConclusionWhile the treatment of urological outpatients in a deployment setting resembles the treatment of soldiers in Germany, BRIs requires abdominal/retroperitoneal urosurgical skills and basic skills in reconstructive surgery.

Assessment of Risk Factors for Iatrogenic Genitourinary Injuries During a Proctectomy.

It is critical to avoid iatrogenic injuries affecting genitourinary organs in order to prevent postoperative urinary or sexual dysfunction, which lead to lengthier recovery and possibly reoperation. Using the 2016-2019 American College of Surgeons National Quality Improvement Program (ACS NSQIP) Targeted Proctectomy Database, we collated 2577 patients with non-metastatic rectal cancer who underwent a laparoscopic or open proctectomy. Univariate analysis was used to identify differences in perioperative factors and genitourinary injuries (GUIs) between operative approaches, and multivariate logistic regression was used to identify independent risk factors for sustaining an intraoperative GUI. The rates of preoperative comorbidities were significantly higher among patients who received an open operation. The proportion of GUIs was also significantly higher in this patient population. Multivariate logistic regression demonstrated that patients who underwent a laparoscopic proctectomy were associated with a 51.4% lower risk of sustaining a GUI. Furthermore, >10% body weight loss in the past 6 months and ASA class 3 status were independently associated with a higher risk of GUI regardless of operation type. Patients who undergo a laparoscopic proctectomy are associated with a lower risk of GUI. On the other hand, patients with >10% body weight loss and ASA class 3: Severe Systemic Disease were associated with a higher risk of GUI.

Problems in diagnosing and treating children – victims of sexual abuse, including legal aspects

Abstract Introduction. The most frequent source of information on sexual violence are the victims. It should be borne in mind that children rarely disclose sexual abuse directly, and the symptoms depend on how long they have been sexually abused, the relationship with the perpetrator, the kind of sexual activities, and factors related to the child’s development. The obvious consequences of child sexual abuse are body injuries: genitourinary tract infections and injuries to the external genitalia. Notwithstanding, the psychological consequences are more serious than the physical injuries. Aim. The study aimed to present the problem of sexually abused children including diagnostics and therapy of victims of violence. Conclusions. The effects of sexual abuse of a child include, in addition to physical trauma, also the disruption of proper psychosexual development. The task of doctors, nursing staff , educators, and psychologists is to efficiently and confidently identify the crime, enabling the initiation of therapeutic activities and legal proceedings.

44 - Peculiarities of the genitourinary system injuries in modern war

44 - Peculiarities of the genitourinary system injuries in modern war

Hemipelvectomy following Trauma: Burden less Identified. A Ten-year Experience from the Level-1 Trauma Center

Introduction:Hemipelvectomy occurs seldom, yet it is a serious injury. Hemipelvectomy following trauma is associated with high incidence of morbidity and mortality. Successful management requires early recognition with a multi-speciality approach and meticulous surgical technique.Method:Retrospective data from hospital records of the Level-1 Trauma Center, between December 2011 through September 2022 was obtained. Clinical details including mechanism of injury, trauma scoring, associated injuries, hemodynamic status, surgical procedures, wound complications, ICU stays, hospital stay, prosthesis application, and their outcome were analyzed. Patients were followed up physically in OPD or telephonically.Results:Total footfall 615,274 patients with 16,786 admissions in trauma surgery, 1,299 amputations and 13 hemipelvectomy patients during the study period of ten years. Seven were in shock on presentation, of which, four were non responders and three responded to initial resuscitation. Seven patients had associated Genitourinary injuries, four had anorectal involvement, five had vascular injuries and six had associated extremity injuries. Six patients underwent hemipelvectomy in the primary surgery and seven ended up in hemipelvectomy on consecutive surgeries. Multiple surgeries were required for all the patients both for control of local sepsis and adequate soft tissue cover. Eight of thirteen patients developed wound infections, and related sepsis, one survived a covid infection and three had MODS. Four out of thirteen patients died and of the nine survivors, prosthesis is being used by three patients, two returned to work without prosthesis and two lost to follow up.Conclusion:With a multidisciplinary and dedicated team approach, we can expect favorable outcomes in post-trauma hemipelvectomy patients.

The management of accidental perineal injuries in pediatric females: Retrospective review at a single institution

BackgroundThe indications for operative management of pediatric perineal injuries are debated. We aimed to investigate our institution's experience with perineal injuries in girls and identify factors for which patients require examination under anesthesia (EUA). MethodsAll female pediatric patients presenting to our institution June 2015–2021 with an isolated perineal injury were reviewed. Demographics, symptoms, exam findings, Genitourinary Injury Score (GIS), and management strategy were recorded and analyzed. Patients were divided based on level of intervention – bedside examination without sedation, Emergency Department (ED) exam with sedation, or EUA. ResultsIn total, 202 patients with a median age of 6 years were analyzed. Bleeding was reported most frequently by patients and families (90.1%), but only 27.2% of patients had bleeding noted on ED exam. Over half of patients (n = 110, 54.5%) were managed nonoperatively; the remaining 92 (45.5%) underwent EUA. The majority of patients (n = 150, 74.3%) had a GIS of I. EUA patients had a higher estimated median total injury size (2.5 (1.5–3.5) cm vs 1.0 (0.5–1.5) cm, p < 0.001), higher percentage of active bleeding (53.3% vs. 4.8%), and higher GIS (≥ II). No one discharged from the ED required operative intervention at a later time. ConclusionAlthough further prospective evaluation is required, our investigation suggests the majority of patients presenting with perineal injuries can be managed in the emergency department, but operative intervention should be considered for patients presenting with active bleeding on physical exam, laceration or hematoma > 2 cm, or GIS ≥ II.