Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 1
Son 10 yılda ürogenital sistem yaralanması olan çocuklarda klinik yaklaşımlarımız
- Sayfa
- 74–78
- DOI
- —
Özet
Acil birime başvuran travmalı olguların yaklaşık %10'unda urogenital sistem etkilenmektedir. Böbrekler, üriner sistemde en sık travmaya maruz kalan organlardır. Yaralanmaların çoğu motorlu araç kazaları sonucunda oluşmaktadır. Ciddi komplikasyonların önlenebilmesi için erken tanı ve tedavi önemlidir. Bu retrospektif çalışmanın amacı, kliniğimizde urogenital sistem yaralanması nedeniyle tedavi edilen çocuklarda, etiyolojik faktörlerin, lezyon türlerinin ve tedavi modalitelerinin irdelenmesidir. Bu çalışmaya, yaşları 2 ile 15 arasında (ortalama yaş: 9.8 yıl) değişen 56 urogenital travmalı çocuk dahil edildi. Bu hastaların 47'si erkek, 9'u kız çocuktu. Travmaların nedenleri 30 olguda (%53) trafik kazası, 17 olguda (%30.3) yüksekten düşme, 6 olguda (%10.7) sportif yaralanma iken, 3 (%5.3) olguda hayvan saldırısı idi. Elli altı urogenital travma olgusunun 26'sı böbrekte, 15'i skrotumda, 6'sı mesanede, 9'u üretrada ve bir tanesi de peniste idi. Bu olguların 6'sında (%10.7) urogenital sistem dışı organ yaralanması da olaya eşlik ediyordu. Yirmi-altı böbrek yaralanmalı olgunun 7'sinde grade I, 5'inde grade II, 1 'inde grade III, 4'ünde grade IV ve 9'unda grade V yaralanma mevcuttu. Yirmi altı böbrek yaralanmanın 13'ü konservatif yöntemlerle tedavi edilirken, 2 olguya parsiyel nefrektomi ve 2 olguya da primer böbrek onarımı yapıldı. At ısırmasına bağlı bir hastaya orşidektomi uygulandı, iki olguda tek seanslı üretral onarım yapıldı. Hastaların 45'i (%80.3) ortalama 23.2 ay (3 ile 96 ay) takip edildi ve sadece 2 olguda üretral darlık gelişti. Bölgemizde urogenital travmaların en yaygın sebebi trafik kazalarıdır. Urogenital travmalı çocukların çoğunda, erken tanı ve uygun tedavi ile iyi fonksiyonel ve kozmetik sonuçlar mümkündür.
Abstract
Introduction: About 10% of all injuries seen in the emergency room involve the genitourinary system. Renal injuries are the most common injuries of the urinary system. Most injuries occur from blunt abdominal trauma such as motor vehicle accidents, fights, falls, and contact sports. Lower genitourinary injury should be considered in all patients with pelvic fractures, although it is seldom a direct cause of death. Significant long-term complications can occur if these injuries are not identified and treated during the initial management. Early diagnosis and treatment are essential to prevent serious complications. The aim of this retrospective study was to analyze the etiologic causes, types of lesions and treatment modalities of genitourinary injuries in children who were treated in our clinic. Materials and Methods: The study included 56 children. Their ages ranged between 2 and 15 years (mean age: 9.8 years). Of these patients 47 were boys and 9 were girls. The causes of trauma were traffic accidents in 30 (53%), fall down from higher places in 17 (30.3%), sportive traumas in 6 (10.7%) and the animal attack in 3 (5.3%). Results: Of the 56 urogenital traumas, 26 were in the kidneys, 15 in the scrotum, 6 in the bladder, 9 in the urethra and 1 was in the penis. The accompanied extra-genitourinary organs damage was seen in 6 children (10.7%). Of the 26 renal lesions 7 were grade I, 5 grade II, 1 grade III, 4 grade IV and 9 grade V. In the treatment of these patients, preference was given to organ sparing operations when possible, but 34.6% of renal injuries required nephrectomy. Of the 26 renal traumas, 13 were treated with a conservative nonoperative approach, while 2 underwent partial nephrectomy and 2 renal lacerations were repaired. One patient with scrotal trauma due to horse bite underwent orchidectomy. The patients who had scrotal traumas underwent scrotal hematoma evacuation and primary skin closure. We preferred one stage reconstruction of the urethral rupture defect in 2 patients. Forty-five (80.3%) patients were followed for a mean of 23.2 months (ranged from 3 to 96 months) and urethral stricture developed in only 2 patients. Conclusion: In this study, the most common pediatric genito-urinary injuries were renal traumas. Abdominal CT is the preferred diagnostic modality in stable patients in our clinic, because it better delineates renal parenchymal injuries, detects urine extravasations, assesses nonviable tissues, and detects associated injuries. In conclusion, in our region, traffic accidents are the most common causes of genitourinary trauma. Excellent functional and cosmetic results can possible in most genitourinary traumas of children with early diagnosis and appropriate treatment.