Pediatric Trauma and Reconstructive Urology
Core concepts
Understand the evaluation of pediatric renal trauma: mechanism, hemodynamic stability, and CT with contrast; most blunt renal injuries are managed nonoperatively. Recognize the grading of renal injury and indications for intervention. Urethral injury in children is often associated with pelvic fracture; retrograde urethrogram is diagnostic, and suprapubic drainage may be needed. Bladder injury from blunt trauma requires cystography. Testicular trauma and torsion are emergencies; time to detorsion matters. Reconstructive topics: hypospadias repair principles, ureteral reimplantation, bladder augmentation, and the use of buccal mucosa for stricture repair. Understand the role of tissue transfer and the importance of preserving blood supply. Recognize complications of reconstruction such as stricture, fistula, and reflux.
Traps
- Ordering retrograde urethrogram in a hemodynamically unstable patient before resuscitation.
- Missing associated injuries in pelvic fracture urethral trauma.
- Assuming all renal trauma needs surgery; most blunt injuries are managed nonoperatively.
- Delaying detorsion in testicular torsion.
Worked example
A child with a pelvic fracture and blood at the meatus should undergo retrograde urethrogram after stabilization; suprapubic catheter drainage may be used if urethral continuity is disrupted.
Rule of thumb
Stabilize first, image second; most pediatric renal trauma is nonoperative, but urethral and bladder injuries need contrast studies.