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Trauma to the bladder neck, trigone and vagina in children
Insights
Bladder neck injuries in children from abdominal trauma require prompt evaluation and surgical repair. Early intervention is crucial for restoring the bladder neck and ensuring future urinary continence.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Pediatric Radiology
Background:
- Blunt lower abdominal trauma can cause rare but serious bladder neck injuries in children.
- These injuries involve disruption at the vesicoprostatic junction in boys and the vesicovaginal septum in girls.
Observation:
- Diagnostic imaging is essential, including excretory urography, voiding cystography, cystovaginoscopy, and retrograde urethrography.
- A high index of suspicion for vaginal injury is necessary in girls.
Findings:
- Anterior disruption at the bladder neck (vesicoprostatic junction) can occur in boys.
- Rupture through the vesicovaginal septum, with or without vesicourethral avulsion, can occur in girls.
Implications:
- Immediate evaluation and early surgical intervention are critical.
- Surgical repair aims to realign the vesicourethral junction and repair associated injuries.
- Prompt treatment improves the chances of achieving subsequent urinary continence.
Abstract:
Although rare, injury to the bladder neck can occur in children following blunt lower abdominal trauma. Anterior disruption at the bladder neck (vesicoprostatic junction) may occur in boys, while rupture through the vesicovaginal septum may occur with or without vesicourethral avulsion in girls. Immediate evaluation, including excretory urography, voiding cystography, cystovaginoscopy (with a high index of suspicion of vaginal injury in girls) and retrograde urethrography (in boys), is indicated to delineate the extent of injury. Early surgical intervention is necessary to achieve realignment of the vesicourethral junction, repair a vesicovaginal injury, if present, and help assure the best chance of subsequent continence.