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Genitourinary injuries in the newborn
H I Patel1, K P Moriarty, P A Brisson
1Division of Pediatric Surgery, The Floating Hospital for Children, Boston, MA, USA.
Insights
Newborn genitourinary trauma, often from circumcision or cesarean sections, can cause severe injuries requiring surgical repair. Prompt intervention is crucial for managing these rare but significant iatrogenic complications.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Urology
Background:
- Common newborn procedures like circumcision and cesarean sections carry a risk of iatrogenic genitourinary trauma.
- While rare, these complications can be significant and require specialized surgical management.
- This study reviews seven cases of neonatal genitourinary trauma, detailing their surgical treatment and outcomes.
Observation:
- Gomco clamp injuries included penile shaft degloving, treated with skin grafting.
- Mogen clamp injuries to the glans resulted in hemorrhage and altered appearance; one required glanoplasty.
- Urethral injury from a Gomco clamp necessitated hypospadias repair.
- Cesarean section led to a severe perineal laceration involving the rectum, requiring complex repair.
Findings:
- Genitourinary trauma in newborns, though infrequent, often demands substantial surgical intervention.
- Circumcision was the primary cause of injury in most reported cases.
- Cesarean-related perineal trauma, as seen in one case, is exceptionally rare and can be life-threatening.
Implications:
- Highlights the importance of meticulous surgical technique during neonatal procedures.
- Underscores the need for specialized pediatric surgical care for iatrogenic genitourinary injuries.
- Emphasizes the potential for severe complications even in routine procedures, necessitating vigilance and skilled management.
Background:
Circumcisions and cesarian sections are common procedures. Although complications to the newborn child fortunately are rare, it is important to emphasize the potential significance of this problem and its frequent iatrogenic etiology. The authors present 7 cases of genitourinary trauma in newborns, including surgical management and follow-up.
Methods:
The authors relate 7 recent cases of genitourinary trauma in newborns from a children's hospital in a major metropolitan area.
Results:
Case 1 and 2: Two infants suffered degloving injuries to both the prepuce and penile shaft from a Gomco clamp. Successful full-thickness skin grafting using the previously excised foreskin was used in 1 child. Case 3, 4, and 5: A Mogen clamp caused glans injuries in 3 infants. In 2, hemorrhage from the severed glans was controlled with topical epinephrine; the glans healed with a flattened appearance. Another infant sustained a laceration ventrally, requiring a delayed modified meatal advancement glanoplasty to correct the injury. Case 6: A male infant suffered a ventral slit and division of the ventral urethra before placement of a Gomco clamp. Formal hypospadias repair was required. Case 7: An emergent cesarean section resulted in a grade 4-perineal laceration in a female infant. The vaginal tear caused by the surgeon's finger, extended up to the posterior insertion of the cervix and into the rectum. The infant successfully underwent an emergent multilayered repair.
Conclusions:
Genitourinary trauma in the newborn is rare but often necessitates significant surgical intervention. Circumcision often is the causative event. There has been only 1 prior report of a perineal injury similar to case 7, with a fatal outcome.
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