Urinary tract injuries in children: are they different from adults?

A retrospective study was carried out of 103 consecutive cases of urologic trauma in childhood. All data were compared with those of a study in 550 adult urological trauma patients to identify problems specific to the paediatric age group. Differences in anatomy and physiology make children more likely to sustain urological injury than adults, in cases of direct as well as indirect trauma. In childhood there is a significant higher incidence of preexisting renal disease. Assessment of urinary tract injuries in paediatric patients requires a higher index of suspicion and a broader indication for immediate radiographic evaluation. The therapeutic approach of urinary tract injuries in children should be identical to that in adults. The controversial renal lacerations can be managed medically (shallow renal lacerations) as well as surgically (major bleeding or extravasation, transsection of the kidney). Whenever possible, operation should be performed as an elective delayed procedure 2 to 6 days after injury. With this approach maximal renal salvation can be achieved without raising overall mortality and morbidity rates.