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Missed urological injuries in children with polytrauma
V C Onuora1, M G Patil, A N al-Jasser
1Department of Urology, Central Hospital, Riyadh, Kingdom of Saudi Arabia.
Insights
Severe urinary tract injuries in children are often missed, even with advanced imaging. Early diagnosis requires heightened clinical awareness and thorough examination to reduce patient morbidity.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Urology
Background:
- Severe urinary tract injuries in children are frequently associated with multiple-organ trauma.
- Accurate and timely diagnosis is crucial for effective management and minimizing morbidity.
Purpose of the Study:
- To evaluate the diagnostic challenges and outcomes of severe urinary tract injuries in pediatric patients admitted to a tertiary care hospital.
- To highlight the importance of clinical suspicion in diagnosing these injuries.
Main Methods:
- Retrospective review of 15 pediatric patients with severe urinary tract injuries admitted between 1990 and 1992.
- Diagnostic evaluation included intravenous urography, CT scans, and ultrasonography.
- Analysis of associated injuries and diagnostic delays.
Main Results:
- Commonly associated injuries involved the skeletal system, spleen, and liver.
- Four cases (ureteropelvic junction injuries and urethropaginal fistulas) were initially undiagnosed.
- Diagnostic delays led to increased patient morbidity.
Conclusions:
- Modern radiological imaging alone may not suffice for diagnosing all severe pediatric urinary tract injuries.
- Heightened clinical awareness and comprehensive physical examination are essential for early detection in children with multiple injuries.
- Prompt diagnosis is critical to prevent long-term complications and improve patient outcomes.
Abstract:
Fifteen children (11 boys and 4 girls) with severe injuries of the urinary tract were admitted to the Riyadh Central Hospital between 1990 and 1992. Their ages ranged from 2.5 to 12 years (mean 7.3 years), and their injuries were parts of multiple-organ trauma. Following resuscitation, every child was evaluated and staged by either intravenous urography, CT scan or ultrasonography or a combination of these. Commonly associated injuries were to the skeleton, spleen and liver. Two patients with ureteropelvic junction injuries and two girls with traumatic urethropaginal fistulas were not diagnosed. The delay in diagnosis contributed to an increase in morbidity. Despite modern radiological imaging, some severe injuries of the urinary tract can still be missed. Heightened awareness and thorough clinical examination are mandatory for early diagnosis of such injuries in children with multiple injuries.