Genitourinary injuries in the newborn

Presented at the 31st Annual Meeting of the American Pediatric Surgical Association, Orlando, Florida, May 25-29, 2000.
https://doi.org/10.1053/jpsu.2001.20062Get rights and content

Abstract

Background: Circumcisions and cesarian sections are common procedures. Although complications to the newborn child fortunately are rare, it is important to emphasize the potential significance of this problem and its frequent iatrogenic etiology. The authors present 7 cases of genitourinary trauma in newborns, including surgical management and follow-up. Methods: The authors relate 7 recent cases of genitourinary trauma in newborns from a children's hospital in a major metropolitan area. Results: Case 1 and 2: Two infants suffered degloving injuries to both the prepuce and penile shaft from a Gomco clamp. Successful full-thickness skin grafting using the previously excised foreskin was used in 1 child. Case 3, 4, and 5: A Mogen clamp caused glans injuries in 3 infants. In 2, hemorrhage from the severed glans was controlled with topical epinephrine; the glans healed with a flattened appearance. Another infant sustained a laceration ventrally, requiring a delayed modified meatal advancement glanoplasty to correct the injury. Case 6: A male infant suffered a ventral slit and division of the ventral urethra before placement of a Gomco clamp. Formal hypospadias repair was required. Case 7: An emergent cesarean section resulted in a grade 4-perineal laceration in a female infant. The vaginal tear caused by the surgeon's finger, extended up to the posterior insertion of the cervix and into the rectum. The infant successfully underwent an emergent multilayered repair. Conclusions: Genitourinary trauma in the newborn is rare but often necessitates significant surgical intervention. Circumcision often is the causative event. There has been only 1 prior report of a perineal injury similar to case 7, with a fatal outcome. J Pediatr Surg 36:235-239. Copyright © 2001 by W.B. Saunders Company.

Section snippets

Materials and methods

All patients referred to the pediatric surgical service between July 1995 and June 1998 for genitourinary injuries were included. These patients were all newborn children (6 boys and 1 girl), and all sustained injuries related to either circumcision or cesarean section. We excluded injuries beyond the perinatal period (7 days). There were no other injuries in any of these neonates. There were no deaths in this series, and follow-up (1 to 4 years) examination showed satisfactory functional and

Discussion

It is well known that trauma is a major cause of morbidity and mortality in the pediatric population.5, 7 The newborn child is relatively spared from trauma until they are more mobile. Unfortunately, however, they are not as protected against iatrogenic injuries. Although genitourinary trauma is dealt with comprehensively in many reports,1, 2, 3, 4 these series illustrate the rarity of noniatrogenic newborn genitourinary injuries. Circumcisions and birth trauma account for the majority of cases.

Acknowledgements

The authors thank Kenneth Kenigsberg, MD, from Garden City, NY for sharing his experience of repairing a grade IV perineal tear with us.

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