Urogenital and Perineal Trauma

Introduction Trauma is a leading cause of death in children in developed countries.1,2 In Africa, as in many developing countries where malnutrition and infectious diseases are leading causes of death in children, trauma may not be encountered as often by the surgeon. As developing countries improve the general health care of children with better nutrition and control of infectious disease vectors, however, trauma is becoming a leading cause of death in children in Africa. This is largely due to the rise of high-speed motor vehicle travel and increasing traffic congestion along poorly developed transportation routes. Most areas lack emergency response systems with trained personnel, adequate emergency transport vehicles, and avenues for medical evacuation to higher echelons of care, which are critical to the survival and decreased morbidity. Dilapidated vehicles traveling on these roads often add to the burden of trauma in these regions.3 Many of these young trauma victims arrive to the surgeon a long time after injury, so the surgeon operating in developing countries must be prepared to quickly and accurately evaluate and manage these youngsters in order to save lives and decrease morbidity from urinary tract injuries.4 The urogenital tract is involved in up to 12% of children with abdominal and pelvic trauma.1 The same mechanisms causing injury to the urinary and genital systems also frequently involve the perineum and challenge the surgeon who is attempting to evaluate the extent of injury. After conducting the primary survey and instituting resuscitative measures, the surgeon will need to employ diagnostic imaging studies to evaluate and identify the urological injuries that can be managed nonoperatively. Advances in radiological imaging have led to a greatly decreased number of unwarranted exploratory operations because some of these patients can be managed nonoperatively.5 In settings with limited facilities, the use of a simple protocol in children with blunt abdominal trauma could lead to a reduction in laparotomy and mortality rates.3