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Wirjopranoto S, Alkaff FF, Yogiswara N, Azmi YA, Purba AKR, Soetanto KM. Pediatric genitourinary injuries: 7-year experience at the largest tertiary referral hospital in Eastern part of Indonesia. J Pediatr Urol 2024; 20:117.e1-117.e5. [PMID: 37863703 DOI: 10.1016/j.jpurol.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/28/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION The anatomical variations between children and adults render pediatric patients more prone to urogenital trauma. However, it is not known for certain whether children are more prone to genitourinary trauma than adults. The aim of the study is to scrutinize the characteristic of pediatric genitourinary trauma at, the largest tertiary hospital in Eastern part of Indonesia. STUDY DESIGN The design of the study was analytic retrospective gathering medical records of all pediatric patients with urogenital trauma with total sampling. The number of patients, ages, genders, etiology, locations, and management were collected. Data was statistically analyzed using SPSS®, and p < 0.05 was considered statistically significant. RESULTS We found 13.5 (10-15.5) years as the median age in our 60 samples. Boy (75.00%), renal trauma (56.67%), abdominal and pelvic trauma (96.67%), traffic accident (91.67%), suprapubic catheterization (52.17%), and hemodynamically stable (91.67) was among the majority. We also found that non-operative management was in majority. Statistical analysis demonstrated significant differences for management and grade of injury (p < 0.05). DISCUSSIONS This is, to the best of our knowledge, the first study of genitourinary injuries in children who were treated at a tertiary hospital in Indonesia during the course of the 7-year research period. The limitations of this study are retrospective character and conducted in single institution. CONCLUSION The highest incidence of pediatric urogenital trauma is renal trauma due to traffic accident, which often multitrauma. Future prospective multi-center studies should be done to corroborate the results.
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Affiliation(s)
- Soetojo Wirjopranoto
- Department of Urology, Faculty of Medicine, Universitas Airlangga, the Netherlands.
| | - Firas Farisi Alkaff
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, And Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands.
| | - Niwanda Yogiswara
- Department of Urology, Faculty of Medicine, Universitas Airlangga, the Netherlands.
| | - Yufi Aulia Azmi
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Groningen, the Netherlands; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Abdul Khairul Rizki Purba
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, And Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
| | - Kevin Muliawan Soetanto
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
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Pandher M, Song A, Mahajan J, Srinivasan N, Berg C, Fernandez G, Chang C, Medina C, Alwaal A, Weiss R. Characterization of Pediatric Genital Injuries Due to Consumer Products from 2011 to 2020. Urology 2022; 167:201-206. [DOI: 10.1016/j.urology.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
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Yingst B, Reeves PT, Krishnamurthy J, Pasman EA, Nylund CM. Toilet Injuries Presenting to Emergency Departments, 2000-2019: A Different Game of Thrones. Pediatr Emerg Care 2022; 38:e906-e909. [PMID: 35072990 DOI: 10.1097/pec.0000000000002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Toilet training is a major developmental milestone. Unsupervised periods combined with immature gross and fine motor skills may lead to toddler injuries during toilet training. Our aim was to investigate toilet-related injuries (TIs) in children. METHODS Data from the National Electronic Injury Surveillance System were used to evaluate emergency department encounters of children ages 0 to 6 years with TI from 2000 to 2019. RESULTS There were an estimated 142,606 children (95% confidence interval, 115,599-168,613) who presented to the emergency department for TI. Toilets were involved in 95% of injuries, and other potty chairs (PCs) involved 5% of injuries. Children had higher odds of sustaining head injury while using a toilet versus PC (adjusted odds ratio = 1.91; 95% CI, 1.06-3.45). CONCLUSIONS Toilet-related injuries present a high burden of risk to young children. Our data support that the safest vessel for use in toilet training is a PC/training seat as opposed to the toilet.
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[Late complications after blunt renal trauma: A French multicenter study]. Prog Urol 2022; 32:363-372. [PMID: 34998680 DOI: 10.1016/j.purol.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/25/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Among genitourinary traumas, blunt trauma to the kidney are the most frequent: their initial management has been well studied but their development at a distance is poorly documented. The objective of this study was to assess the late complications of blunt renal trauma, and to investigate their predictive factors for occurrence. MATERIALS AND METHODS A retrospective observational study of the TraumAFUF project was conducted, including, between 2005 and 2018, all blunt renal trauma treated in 18 French hospitals and followed for more than 3 months. The characteristics of the initial trauma, as well as any complications occurring after three months, were identified. The patients were divided into two groups: onset of a late complication (LC) or uncomplicated (UC). The groups were compared in univariate and multivariate analyses to identify the risk factors for the occurrence of these complications. RESULTS Among the 454 patients included, 50 presented with LC (11%), as symptomatic morphologically altered kidney (2.9%), secondarily impaired biological renal function (2.9%), or secondary arterial hypertension (2.4%). The risk factors identified were, during initial medical care, a high-grade renal trauma≥IV (OR=2.4, P=0.025), active bleeding (OR=2.6, P=0.007), the need for transfusion (OR=2.3, P=0.001), or interventional (R=1.7, P=0.09) or endoscopic treatment (OR=2.0, P=0.035). CONCLUSION In this study, late complications occurred in 11% of cases after blunt renal trauma. The risk factors identified make it possible to draw up a patient profile who would benefit from prolonged follow-up to detect these complications. LEVEL OF EVIDENCE 3.
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Till D, Ghuman S, Kim L, Roleson R, Morrison J, Wexner S. The Zipperator! A Novel Model to Simulate Penile Zipper Entrapment. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2021; 6:I1-I6. [PMID: 37465270 PMCID: PMC10334444 DOI: 10.21980/j8ns8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/19/2021] [Indexed: 07/20/2023]
Abstract
Audience The Zipperator training model is designed for emergency medicine resident physicians and physicians. Introduction Zipper entrapment injuries are an uncommon cause of penile injury in the emergency department, representing an incidence of less than 0.5% of pediatric emergency department visits.1 However, they are one of the most common causes of genital injuries in young boys.1,2 Various methods proposed for releasing the entrapped tissue range from the use of mineral oil as lubrication to techniques to release the zipper mechanism or, in extreme cases, surgical procedures.3-6 A well-designed simulated task trainer would allow learners to practice these methods in a controlled environment conducive to learning 7,8. Given the low frequency of the chief complaint and with a wide variety of release techniques available, the purpose of this study was to build a simulation model that could improve learner confidence in troubleshooting this rarely performed procedure. Although past studies have designed similar task trainers, this novel model was built using a low-cost device ("Operation") to provide real-time alarm noises that reasonably simulate distress and procedural anxiety for both the patient and provider. Although pain and anxiety are separate outcomes from zipper entrapment release, including a component of these emotions may mimic the same emotional states that patients, their parental unit, and perhaps their provider may experience regarding this chief complaint given its rarity, anatomic vulnerability, and the overall sensitivity of the complaint's nature. Educational Objectives After training on the Zipperator, learners will be able to:Demonstrate at least two techniques for zipper release and describe how methods would extrapolate to a real patient.Verbalize increased comfort with the diagnosis of zipper entrapment.Present a plan of care for this low-volume, high-anxiety presentation. Educational Methods As part of a voluntary Emergency Medicine curriculum at two different sites, we constructed an inexpensive model for penile zipper entrapment using a household gameboard, "Operation," and materials that are easily obtainable and assembled in any emergency department. "Operation" was selected for its ability to produce alarm noises in response to excessive movement, which would reasonably simulate distress and procedural anxiety that may be experienced by both the patient and provider. This task trainer was used to teach medical students and post graduate year (PGY) 1-4 resident learners. A brief hypothetical situation was presented to learners, highlighting patient and paternal unit anxiety. Following this, learners were given a survey and asked to complete pre-model training questions immediately prior to using the simulated model. Learners were then given the opportunity for hands-on skills-based practice. Postmodel training questions were made available in the same survey immediately following the exercise. Research Methods This exercise was offered at two sites over a two-year period. Sixty learners participated in the exercise. Participation was voluntary, was not graded nor shared with the residency director, and all feedback was formative in nature. Selected faculty and research assistants provided asynchronous opportunities for learners to practice on the model. Before the exercise, the faculty or research assistant on site presented a brief hypothetical situation to simulate patient and paternal unit anxiety that could be expected in this chief complaint. Each learner was then allowed to select a variety of tools and methods to practice zipper entrapment release. Learners were asked to begin a survey prior to training on the model, and then complete the survey immediately after training on the model to evaluate its educational value. The survey created for this study consisted of a structured questionnaire that contained close-ended questions. Measures evaluated include experience with prior zipper entrapments, comfort with zipper entrapments before and after training on the simulated model, and user experience. Results Before the exercise, 68.3% of learners described their comfort with managing future zipper entrapments as very uncomfortable or totally uncomfortable. Although only 8.3% of learners had treated the zipper entrapment complaint prior to the exercise, 100% of those who had experienced treating the complaint felt that the simulated model was at least somewhat reflective of their experience with a real patient. 71.7% of the learners found the experience enjoyable, although 20% found the experience totally unenjoyable, of note, for unclear reasons and with unclear significance or etiology. After the exercise, 71.7% of learners indicated they felt comfortable to very comfortable regarding future cases of zipper entrapment. Discussion Through the use of a well-known household board game and supplies commonly found in the emergency department, we created a simulated model that could be easily replicated. This simple model provided practice of the hand motions necessary for zipper entrapment release, as well as familiarity with the mental and physical approaches to dislodging the entrapment. The resident physicians who had had a prior zipper entrapment patient reported the model was somewhat similar to actual patient encounters. Overall, this model was well-received by the learners, with most expressing it was enjoyable and feeling it increased their confidence for treating this chief complaint. Some learners had noted the experience was totally unenjoyable. This measure may not be an appropriate endpoint, however, and incongruencies may be addressed by implementing prizes or friendly competition for enjoyment. Another limitation of this study is the leap taken between movement and patient comfort. While possible that learners can manipulate the model to reduce movement of the needle without meaningful reduction in zipper movement, observation by the instructor was sufficient to ensure this finding was not observed in our learner population. We therefore submit this cheap, simple model as a potential method to teach approaches to teaching a low frequency, high anxiety chief complaint. Topics Penile entrapment model, penile entrapment release, Emergency Medicine, Urology, Clinical/Procedural Skills Training.
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Affiliation(s)
- Dale Till
- University of California Davis, Department of Emergency Medicine, Davis, CA
| | - Simran Ghuman
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Luke Kim
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Ryan Roleson
- Kern Medical Center, Department of Emergency Medicine, Bakersfield, CA
| | - Jessica Morrison
- University of Pittsburgh Medical Center, Department of Emergency Medicine, Pittsburgh, PA
| | - Sage Wexner
- Kern Medical Center, Department of Emergency Medicine, Bakersfield, CA
- Kern Medical Center, Simulation Center, Bakersfield, CA
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Hoshi R, Uehara S, Hashimoto M, Hosokawa T, Kawashima H, Kaneda H, Hoshino M, Koshinaga T. Diagnosis and management of genital injuries in girls: 14-year experience. Pediatr Int 2021; 63:523-528. [PMID: 32853468 DOI: 10.1111/ped.14448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric patients with genital injuries are often recommended to receive an examination under general anesthesia; however, detailed clinical data of such patients are rarely reported. METHODS A single-center retrospective review was conducted in 45 girls less than 16 years of age with genital injuries between January 2005 and December 2018. RESULTS The median patient age was 5.0 years. Forty-two patients were hospitalized, of whom 38 required an examination under general anesthesia and all consequently required surgical repair. The diagnosis obtained after a thorough examination under general anesthesia was inconsistent with the diagnosis obtained at the emergency room in five patients. In 20 patients, the source of bleeding was not clarified at the time of initial examination at the emergency room; four of these patients were later revealed to have vaginal or rectal injuries that had been overlooked during the examination at the emergency room. Injuries occurring in the bathroom were the most frequent and tended to be serious. Multiple injuries were found in 10 patients. The exterior of the labia minora was the most commonly injured site, found in 18 patients. CONCLUSIONS We analyzed the clinical data of girls with genital injuries in detail, which allowed us to find a detailed classification of injured sites and the characteristics of serious cases, and to re-recognize the importance of a thorough examination under general anesthesia.
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Affiliation(s)
- Reina Hoshi
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Hashimoto
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Hosokawa
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Kawashima
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hide Kaneda
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mayumi Hoshino
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
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Nabavizadeh B, Namiri NK, Hakam N, Li KD, Amend GM, Breyer BN. Playground Equipment-related Genital Injuries in Children: An Analysis of United States Emergency Departments Visits, 2010-2019. Urology 2021; 152:84-90. [PMID: 33775786 DOI: 10.1016/j.urology.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/05/2021] [Accepted: 03/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the demographics, epidemiology, and common mechanisms associated with playground equipment-related genital injuries in children. METHODS We examined the National Electronic Injury Surveillance System database to obtain playground-related genital injuries sustained in children ≤17 years from 2010 to 2019. Demographics of the patients and injury characteristics were analyzed using sample weights to produce national estimates. RESULTS During the study period, an estimated 27,738 (95% confidence interval 18,602-36,874) emergency department visits with an average annual incidence of 3.8 (95% confidence interval 2.5-5) per 100,000 United States population ≤17 years were reported. The mean age was 6.6 (standard error 0.152) years with most injuries occurring in pre-school children (48.1%) and females (81.1%). Over ½ of genital injuries (55.2%) were associated with climbing apparatus. This was followed by slides (10.7%), swings (9%), and seesaws (4.8%). Most genital injuries occurred at public (41.4%) and school settings (36.3%). Straddling and/or falling was the most common mechanism leading to genital injuries (84.4%). The incidence of injuries remained constant during the 10-year study period (change = + 2.6%; r2 = 0.121, P = .326). Monthly variations in the number of injuries existed with peak injuries in April-May, and September-October. CONCLUSION Despite current safety standards, genital injuries arising from playground equipment have remained stable since 2010. By defining common devices, mechanisms, and conditions associated with genital injuries, this study may help guide efforts aimed at the prevention of such injuries in various locations.
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Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nikan K Namiri
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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Takei H, Nomura O, Hagiwara Y, Inoue N. The Management of Pediatric Genital Injuries at a Pediatric Emergency Department in Japan. Pediatr Emerg Care 2021; 37:73-76. [PMID: 29698336 DOI: 10.1097/pec.0000000000001489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Genital injuries among children are often associated with consumer products or specific activities. There are few descriptive studies from Asia on pediatric genital injuries seen in the emergency department (ED). The aim of this study was to describe the characteristic features of accidental genital injuries among children. METHODS A retrospective chart review of children aged 15 years or younger who visited our ED for genital injuries between March 2010 and November 2014 was conducted. Data on age, arrival time at the ED, location of the incident, mechanism of injury, objects, injured organ, consultation with specialists, emergency operation, sedation at the ED, and outcomes were collected and analyzed. RESULTS One hundred seventy-nine patients were included in this analysis. Girls comprised 71% of the subject pool. The median age was 6 years (interquartile range, 4-9 years). Straddle injuries were the most common form of injury (56%). Male genital injuries occurred mostly outdoors (64%). Common consumer products associated with pediatric genital injuries were furniture (21%), exercise equipment (17%), and bicycles (15%). Thirty-two patients were examined by a surgeon, gynecologist, or urologist. The most commonly injured organs were the penis (55%) in boys and the labia (60%) in girls. Most patients (93%) were treated at the ED and discharged. CONCLUSIONS The characteristics of accidental genital injuries among Japanese children were similar to those of children in other countries. The strategy for preventing genital injuries used in the West might be applicable to the East Asian context.
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Affiliation(s)
- Hirokazu Takei
- From the Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Tembely S, Dieth AG, Kouamé YGS, Yaokreh JB, Odéhouri-Koudou TH, Kouamé DB, Ouattara O. Trauma of the external genital in children: Emasculation, a paediatric case report. Trauma Case Rep 2019; 21:100201. [PMID: 31111085 PMCID: PMC6510701 DOI: 10.1016/j.tcr.2019.100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2019] [Indexed: 11/30/2022] Open
Abstract
An 8-year-old boy was brought to the paediatric surgery department having amputated his penis and both testicles during a road traffic accident. Examination of the perinea showed a complete amputation of penis, scrotum and testicles. We performed debridement and skin suture initially. The urethral orifice was catheterized by a 10 F Foley's catheter. I the herein case report, we discuss the incidence, management and complications of genital amputation in a young boy. Moreover, the existing literature in this subject is reviewed.
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Affiliation(s)
- S Tembely
- Pediatric Surgery Department, CHU de Yopougon, 21 BP 632, Abidjan 21, Côte d'Ivoire
| | - A G Dieth
- Pediatric Surgery Department, CHU de Yopougon, 21 BP 632, Abidjan 21, Côte d'Ivoire
| | - Y G S Kouamé
- Pediatric Surgery Department, CHU de Yopougon, 21 BP 632, Abidjan 21, Côte d'Ivoire
| | - J B Yaokreh
- Pediatric Surgery Department, CHU de Yopougon, 21 BP 632, Abidjan 21, Côte d'Ivoire
| | - T H Odéhouri-Koudou
- Pediatric Surgery Department, CHU de Yopougon, 21 BP 632, Abidjan 21, Côte d'Ivoire
| | - D B Kouamé
- Pediatric Surgery Department, CHU de Yopougon, 21 BP 632, Abidjan 21, Côte d'Ivoire
| | - O Ouattara
- Pediatric Surgery Department, CHU de Yopougon, 21 BP 632, Abidjan 21, Côte d'Ivoire
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Casson C, Jones RE, Gee KM, Beres AL. Does Microscopic Hematuria After Pediatric Blunt Trauma Indicate Clinically Significant Injury? J Surg Res 2019; 241:317-322. [PMID: 31055157 DOI: 10.1016/j.jss.2019.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/20/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Children are more likely to have urinary system injury after blunt abdominal trauma (BAT) because of anatomical vulnerabilities. Urinalysis (UA) is often performed during initial evaluation to screen for injury. The purpose of this study was to determine how often finding microscopic hematuria after BAT leads to further testing and whether this indicates a significant injury. METHODS A retrospective review of children evaluated for BAT at Children's Health from 2013 to 2017 was performed. Patients included had microscopic hematuria on initial UA. Data collected included demographics, injury data, laboratory and imaging data, and outcomes. Analysis was performed using descriptive statistics, Fisher's exact, and independent t-test. RESULTS Of 1059 patients treated for BAT during the study period, 203 (19%) exhibited microscopic hematuria on UA during the initial workup. Most UAs resulted after imaging was completed and did not impact management (158, 78%); twenty-two (14%) of these patients had urinary injury, which were diagnosed by imaging regardless of UA results. Forty-five (22%) patients were found to have microscopic hematuria that independently led to workup for urinary injury. Of these, nine patients had a urinary system injury: 6 low-grade renal and three bladder wall injuries, none of which required surgery. Those with and without urinary injury in this group underwent similar numbers of radiographic studies. CONCLUSIONS Microscopic hematuria on screening UA after BAT may lead to extensive workup, regardless of the presence of symptoms. In patients who receive cross-sectional abdominal imaging, preceding UA adds little to the clinical workup of children with BAT.
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Affiliation(s)
- Cameron Casson
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - R Ellen Jones
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kristin M Gee
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alana L Beres
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Pediatric Surgery, Children's Health, Dallas, Texas.
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Holland AJ, Soundappan SS. Trauma hazards in children: An update for the busy clinician. J Paediatr Child Health 2017; 53:1096-1100. [PMID: 28665528 DOI: 10.1111/jpc.13603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/17/2017] [Indexed: 12/29/2022]
Abstract
Trauma and injury continue to be common in children and remain an important cause of mortality and morbidity. Legislation mandating the use of helmets for all cyclists appears to have been effective in reducing the incidence and severity of head and facial injuries, with no clear evidence of a reduction in cycling usage or activity. Straddle injuries, whilst uncommon and generally minor, require careful clinical assessment as they may be associated with urethral trauma. Quad bikes remain highly dangerous with continuing reports of deaths in child riders due to their inherent lack of stability: a ban on their use by children would seem the most effective solution. The popularity of mobile devices and toys, coupled with the development of higher voltage, lithium button batteries have seen a surge in the number of cases and subsequent complications from ingestion. The problems seen in children following ingestion of high-powered, rare earth magnets in the late 1990s and 2000s has now receded due to legislation introduced in 2012. Inhaled, typically organic foreign bodies remain a diagnostic challenge with rigid bronchoscopy still the most effective diagnostic and therapeutic modality. Corrosive ingestion, now seen much less commonly, continues to be a potentially devastating injury when occurring as a result of caustic soda. Recent publicity concerning the problem of childhood drowning highlights the need for constant parental vigilance, the limitations of pool fencing and the importance of community cardiopulmonary resuscitation training, together with repeated education of the risk of rips when swimming in the sea.
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Affiliation(s)
- Andrew Ja Holland
- Douglas Cohen Department of Paediatric Surgery, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Soundappan Sv Soundappan
- Douglas Cohen Department of Paediatric Surgery, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Abstract
Sexual abuse of children is prevalent in today's society. In 2012, approximately 686,000 children (9.2 per 1000) in the United States were determined to be victims of substantiated child abuse and neglect, according to national data compiled by child protective service agencies; victimization rates were highest for children younger than 1 year. Nearly 9.3% of maltreated children were victims of sexual abuse, this finding was reported by US Department of Health and Human Services (http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment). Previous research has shown that as many as 1 in 3 girls and 1 in 7 boys will be sexually abused during childhood (Child Abuse Negl. 2003;27:1205-1222). Although sexual abuse seems to be less common in boys than girls, this may be partly due to underdiagnosis and underreporting of sexual abuse in boys (Arch Dis Child. 2007;92:328-331). Clinicians should therefore consider the possibility of sexual abuse when boys present with genital injuries, because failing to recognize and diagnose sexual abuse can pose an ongoing safety risk to a child. However, an erroneous diagnosis of sexual abuse can have equally hazardous repercussions, including removal of a child from their caregivers or prosecution of an innocent individual. A number of medical conditions can mimic child sexual abuse injuries, including anal fissures, failure of midline fusion, perianal streptococcal dermatitis, and straddle injury (J Pediatr Health Care. 2009;23:283-288 and Acta Paediatr. 2011;100:590-593). The following case involves a 5-week-old male infant who presented to the pediatric emergency department with an avulsion injury to his penis concerning for sexual abuse. He was ultimately diagnosed with a relatively rare anatomic variant of the genitalia and determined to have sustained an accidental injury whose appearance mimicked abuse.
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Major genitourinary-related bicycle trauma: Results from 20 years at a level-1 trauma center. Injury 2017; 48:153-157. [PMID: 27423305 PMCID: PMC6390953 DOI: 10.1016/j.injury.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/21/2016] [Accepted: 07/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Epidemiological studies have shown that bicycle trauma is associated with genitourinary (GU) injuries. Our objective is to characterize GU-related bicycle trauma admitted to a level I trauma center. MATERIALS AND METHODS We queried a prospective trauma registry for bicycle injuries over a 20-year period. Patient demographics, triage data, operative interventions and hospital details were collected. RESULTS In total, 1659 patients were admitted with major bicycle trauma. Of these, 48 cases involved a GU organ, specifically the bladder (n=7), testis (n=6), urethra (n=3), adrenal (n=4) and/or kidneys (n=36). The median age of cyclists with GU injuries was 29 (range 5-70). More men were injured versus women (35 versus 13). GU-related bicycle trauma involved a motor vehicle in 52% (25/48) of injuries. The median injury severity score for GU-related bicycle trauma was 17 (range 1-50). The median number of concomitant organ injuries was 2 (range 0-6), the most common of which was the lungs (13/48, 27%) and ribs (13/48, 27%). The majority of GU injured cyclists were admitted to an ICU (15/48, 31%) or hospital floor (12/48, 25%). Operative intervention for a GU-related trauma was low (12/48, 25%). The most common GU organ injured was the kidney (36/48, 75%) however most were managed nonoperatively (33/36, 92%). Bladder injuries most often required operative intervention (6/7, 86%). Mortality following GU-related bicycle trauma was low (2/48, 4%). CONCLUSIONS In a large series of bicycle trauma, GU organs were injured in 3% of cases. The majority of cases were managed non-operatively and mortality was low.
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Oquist M, Buck L, Michel K, Ouellette L, Emery M, Bush C. Comparative analysis of five methods of emergency zipper release by experienced versus novice clinicians. Am J Emerg Med 2016; 35:783-784. [PMID: 27836312 DOI: 10.1016/j.ajem.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Mark Oquist
- Michigan State University, College of Human Medicine, Department of Emergency Medicine, United States
| | - Lauren Buck
- Michigan State University, College of Human Medicine, Department of Emergency Medicine, United States
| | - Keegan Michel
- Michigan State University, College of Human Medicine, Department of Emergency Medicine, United States
| | - Lindsey Ouellette
- Michigan State University, College of Human Medicine, Department of Emergency Medicine, United States; Spectrum Health, Department of Emergency Medicine, Grand Rapids, MI, United States.
| | - Matt Emery
- Michigan State University, College of Human Medicine, Department of Emergency Medicine, United States; Spectrum Health, Department of Emergency Medicine, Grand Rapids, MI, United States
| | - Colleen Bush
- Michigan State University, College of Human Medicine, Department of Emergency Medicine, United States; Spectrum Health, Department of Emergency Medicine, Grand Rapids, MI, United States
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Bakal U, Sarac M, Tartar T, Cigsar EB, Kazez A. Twenty years of experience with perineal injury in children. Eur J Trauma Emerg Surg 2015; 42:599-603. [DOI: 10.1007/s00068-015-0576-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/19/2015] [Indexed: 11/24/2022]
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Bagga HS, Fisher PB, Tasian GE, Blaschko SD, McCulloch CE, McAninch JW, Breyer BN. Sports-related genitourinary injuries presenting to United States emergency departments. Urology 2015; 85:239-44. [PMID: 25530389 DOI: 10.1016/j.urology.2014.07.075] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/05/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe epidemiologic features of sports-related genitourinary (GU) injuries and determine patient cohorts and particular sporting activities associated with increased GU injury risk. MATERIALS AND METHODS The National Electronic Injury Surveillance System, a data set validated to provide a probability sample of injury-related US emergency department (ED) presentations, was analyzed to characterize GU injuries between 2002 and 2010. A total of 13,851 observations were analyzed to derive national estimates. RESULTS Between 2002 and 2010, an estimated 137,525 individuals (95% confidence interval, 104,490-170,620) presented to US EDs with GU injuries sustained during sporting activities. Nearly three-quarters of injuries occurred in the pediatric population. The most common product involved was a bicycle, representing approximately one-third of injuries in both adult and pediatric populations. Injuries related to team sports such as football, baseball or softball, basketball, and soccer were also common, particularly among boys where they represented a combined third of all injuries. Eighty-nine percent of all patients were evaluated and treated in the ED without inpatient admission. The large majority of injuries involved the external genitalia (60%), and significant injuries of paired GU organs (kidneys and testicles) requiring inpatient admission were rare (8.5%). CONCLUSION Sports-related GU injuries are most commonly sustained during the use of a bicycle. However, there are other associated activities with identifiable high-risk cohorts, products, and situations. Consumers, practitioners, and injury-prevention experts can use our epidemiologic data to prioritize and develop strategies aimed at the prevention and limitation of such injuries, particularly when counseling at-risk cohorts, such as those with solitary kidneys or testicles.
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Affiliation(s)
- Herman S Bagga
- Department of Urology, University of California, San Francisco, San Francisco, CA.
| | - Patrick B Fisher
- Department of Urology, University of California, Davis, Davis, CA
| | - Gregory E Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah D Blaschko
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Jack W McAninch
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA
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17
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Reply. Urology 2015; 85:245. [DOI: 10.1016/j.urology.2014.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Francis JC, Banaszek TN, Dietrich JE. Use of the Lumitex MD Lightmat® Surgical Illuminator for pediatric genital trauma cases: a retrospective case series. J Pediatr Adolesc Gynecol 2014; 27:e109-11. [PMID: 24581677 DOI: 10.1016/j.jpag.2013.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/08/2013] [Accepted: 08/12/2013] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVES To review the literature regarding repair of pediatric female genital trauma. To review our experience with the use of a lighted retractor at the time of repair of genital trauma in an operating room setting. STUDY DESIGN Retrospective case series. SETTING Texas Children's Hospital. PARTICIPANTS Patients with genital trauma requiring repair in an operating room setting where the Lumitex MD Lightmat Surgical Illuminator (LM) was utilized. INTERVENTIONS Use of the LM in pediatric gynecology patients. RESULTS Of the 16 cases where the LM lighted retractor was utilized, 12 were found to be performed secondary to genital trauma, resulting from straddle injury or coital trauma. Four patients were identified as having either congenital reproductive tract anomalies or foreign body. Patients ranged in age from 1-21 years with a mean age of 9 ± 4.91 years at the time of their vaginal repair. The mean operative time was 82 ± 47 minutes, with cases ranging from 37-182 minutes, with a median blood loss of 7 mL and an average hospital stay of 1.2 days. There were no surgical complications. CONCLUSION Neurosurgeons and otolaryngologists have been optimizing safe visualization of small areas during surgery for years with the use of the LM. In cases of pediatric deep genital trauma, the LM can be used safely for easy visualization, allowing for direct visualization in cases of deep genital trauma.
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Affiliation(s)
- J C Francis
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX.
| | - T N Banaszek
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX
| | - J E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX
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Tasian GE, Appa AA, Bagga HS, Blaschko S, McCulloch CE, McAninch JW, Breyer BN. Bicycle-related genitourinary injuries in the USA from 2002-2010. Inj Prev 2014; 20:350-3. [PMID: 24618096 DOI: 10.1136/injuryprev-2013-041002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Among children, the incidence of bicycle-related genitourinary (GU) injuries was 448 per 100 000 (95% CI 383 to 514) and, among adults, was 53 per 100 000 (95% CI 36 to 71). Although children sustained more injuries, adults were more likely to being admitted to the hospital for the GU injury (OR 1.95, 95% CI 1.13 to 3.37). Children sustain nearly 10 times more GU injuries due to bicycles than adults, but adults have higher odds of sustaining injuries requiring admission.
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Affiliation(s)
- Gregory E Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ayesha A Appa
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Herman S Bagga
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Sarah Blaschko
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jack W McAninch
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
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McAleer IM. Editorial Comment. Urology 2013; 82:1130; discussion 1130-1. [DOI: 10.1016/j.urology.2013.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Glass AS, Bagga HS, Tasian GE, McGeady JB, McCulloch CE, Blaschko SD, McAninch JW, Breyer BN. No small slam: increasing incidents of genitourinary injury from toilets and toilet seats. BJU Int 2013; 112:398-403. [PMID: 23773285 DOI: 10.1111/bju.12173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the epidemiology of genitourinary (GU) injury from toilets that present to USA Emergency rooms (ERs). MATERIALS AND METHODS The National Electronic Injury Surveillance System (NEISS) is a stratified probability sample of hospital ER visits for USA consumer product-related injuries. NEISS was used to estimate total toilet- and toilet seat-related GU injury for the years 2002-2010, as well as to describe demographics and injury characteristics. Analyses were performed using strata, primary sampling units and sample weights to accommodate the complex sample survey design. Data are reported as national estimates with 95% confidence intervals (CIs) provided. RESULTS In all, 13 175 (95% CI 10 185-16 165) GU injuries related to toilets presented to ERs during 2002-2010. The most common mechanism involved crush from accidental fall of toilet seat, described in 9011 (68.4%, 95% CI 6907-11 115) cases. Most crush injuries were isolated to the penis (98.1%). Of crush injuries, 81.7% occurred in children aged 2-3 years and 99.3% occurred in the home. Crush injuries increased over the period 2002-2010 (P = 0.017) by ≈100 per year, ending with an estimated 1707 (95% CI 1011-2402) by 2010. Most patients who sustained toilet- and toilet seat-related GU injuries were treated in the ER and then discharged. CONCLUSION While penile crush injury related to a toilet seat is an uncommon mechanism of urological injury in children, the number of incidents appears to be rising. These findings support educational efforts and interventions, such as exchange of heavy toilet seats with slow-close toilet seat technology.
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Affiliation(s)
- Allison S Glass
- Department of Urology, University of California San Francisco (UCSF), San Francisco, CA 94143-0738, USA
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Abstract
This article reviews recent publications evaluating the current epidemiology of urologic trauma. The authors briefly explain databases that have been recently used to study this patient population and then discuss each genitourinary organ individually, utilizing the most relevant and up-to-date information published for each one. The conclusion of the article briefly discusses possible future research and development areas pertaining to the topic.
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Affiliation(s)
- James B McGeady
- Department of Urology, University of California, San Francisco, CA 94143, USA
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Bagga HS, Tasian GE, Fisher PB, McCulloch CE, McAninch JW, Breyer BN. Product related adult genitourinary injuries treated at emergency departments in the United States from 2002 to 2010. J Urol 2013; 189:1362-8. [PMID: 23127766 PMCID: PMC3681831 DOI: 10.1016/j.juro.2012.10.122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE We describe the epidemiological features of adult genitourinary injuries related to consumer products and determined the patient cohorts, products and situations associated with increased genitourinary injury risk. MATERIALS AND METHODS The National Electronic Injury Surveillance System, a data set validated to provide a probability sample of injury related emergency department presentations in the United States, was analyzed to characterize genitourinary injuries from 2002 to 2010. We analyzed 3,545 observations to derive national estimates. RESULTS An estimated 142,144 adults (95% CI 115,324-168,964) presented to American emergency departments with genitourinary injuries from 2002 to 2010. Of the injuries 69% occurred in men. A large majority of injuries involved the external genitalia. The most common categories of products involved were sporting items in 30.2% of cases, clothing articles in 9.4% and furniture in 9.2%. The highest prevalence of injury was at ages 18 to 28 years (37.5%), which was most often related to sports equipment, such as bicycles. Older cohorts (age greater than 65 years) more commonly sustained injuries during falls and often in the bathroom during use of a shower or tub. Of all patients 88% were evaluated and treated in the emergency department without inpatient admission, although the admission rate increased with increasing patient age. CONCLUSIONS Acute genitourinary injury is often associated with common consumer items and with identifiable high risk cohorts, products and situations. Consumers, practitioners and safety champions can use our epidemiological data to prioritize and develop strategies aimed at the prevention, limitation and informed treatment of such injuries.
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Affiliation(s)
- Herman S. Bagga
- Departments of Urology (HSB, PBF, JWM, BNB) and Epidemiology and Biostatistics (CEM), University of California-San Francisco, San Francisco, California, and Division of Urology, Children's Hospital of Philadelphia (GET), Philadelphia, Pennsylvania
| | - Gregory E. Tasian
- Departments of Urology (HSB, PBF, JWM, BNB) and Epidemiology and Biostatistics (CEM), University of California-San Francisco, San Francisco, California, and Division of Urology, Children's Hospital of Philadelphia (GET), Philadelphia, Pennsylvania
| | - Patrick B. Fisher
- Departments of Urology (HSB, PBF, JWM, BNB) and Epidemiology and Biostatistics (CEM), University of California-San Francisco, San Francisco, California, and Division of Urology, Children's Hospital of Philadelphia (GET), Philadelphia, Pennsylvania
| | - Charles E. McCulloch
- Departments of Urology (HSB, PBF, JWM, BNB) and Epidemiology and Biostatistics (CEM), University of California-San Francisco, San Francisco, California, and Division of Urology, Children's Hospital of Philadelphia (GET), Philadelphia, Pennsylvania
| | - Jack W. McAninch
- Departments of Urology (HSB, PBF, JWM, BNB) and Epidemiology and Biostatistics (CEM), University of California-San Francisco, San Francisco, California, and Division of Urology, Children's Hospital of Philadelphia (GET), Philadelphia, Pennsylvania
| | - Benjamin N. Breyer
- Departments of Urology (HSB, PBF, JWM, BNB) and Epidemiology and Biostatistics (CEM), University of California-San Francisco, San Francisco, California, and Division of Urology, Children's Hospital of Philadelphia (GET), Philadelphia, Pennsylvania
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Bagga HS, Tasian GE, McGeady J, Blaschko SD, McCulloch CE, McAninch JW, Breyer BN. Zip-related genital injury. BJU Int 2013; 112:E191-4. [PMID: 23490164 DOI: 10.1111/bju.12009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the epidemiology of genital injuries caused by trouser zips and to educate both consumers and the caregivers of patients who sustain such injuries. PATIENTS AND METHODS The National Electronic Injury Surveillance System, a dataset validated to provide a probability sample of patients who present to emergency departments (EDs) in the USA with injuries, was analysed to characterize zip-related genital injuries occurring between 2002 and 2010. A total of 523 cases were analysed to obtain national estimates. RESULTS Between 2002 and 2010, an estimated 17,616 patients presented to US EDs with trouser zip injuries to the genitals. The penis was almost always the only genital organ involved. Zip injuries represented nearly one-fifth of all penile injuries. Amongst adults, zips were the most frequent cause of penile injuries. Annual zip-related genital injury incidence remained stable over the study period. CONCLUSIONS Zip-related genital injuries affect both paediatric and adult cohorts. Practitioners should be familiar with various zip-detachment strategies for these populations.
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Affiliation(s)
- Herman S Bagga
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
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25
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This Month in Pediatric Urology. J Urol 2013. [DOI: 10.1016/j.juro.2012.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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