Missed urological injuries in children with polytrauma.

Fifteen children (11 boys and 4 girls) with severe injuries of the urinary tract were admitted to the Riyadh Central Hospital between 1990 and 1992. Their ages ranged from 2.5 to 12 years (mean 7.3 years), and their injuries were parts of multiple-organ trauma. Following resuscitation, every child was evaluated and staged by either intravenous urography, CT scan or ultrasonography or a combination of these. Commonly associated injuries were to the skeleton, spleen and liver. Two patients with ureteropelvic junction injuries and two girls with traumatic urethropaginal fistulas were not diagnosed. The delay in diagnosis contributed to an increase in morbidity. Despite modern radiological imaging, some severe injuries of the urinary tract can still be missed. Heightened awareness and thorough clinical examination are mandatory for early diagnosis of such injuries in children with multiple injuries.