Injury results either from direct impact of a blunt object or from "deceleration", a mechanism whereby the body is in motion, suddenly stops, and an organ such as the kidney continues in motion. This results in injury at the junction of freely moving and fixed points of anatomy. Classic examples in the pediatric patient include ureteropelvic junction (UPJ) disruption or renal artery injury. In those patients admitted to the hospital for care of traumatic injury, the kidney is the most commonly injured organ in the genitourinary system, followed by injuries to the external genitalia, bladder/urethra, and ureter.

For instance, if it was a motor vehicle accident, the doctor may ask about the location, speed, position of the car and the condition of others involved. If the injury resulted from a fall, the doctor will inquire about the height of the fall, and the surface or object that your child collided with when he fell. If it's a sports injury the doctor will want to know about the protective gear worn.

You can also expect to be asked the following:

The doctor will also look for any external evidence of trauma, and will pay close attention to your child's gait, if the child can walk. The doctor will feel the flank area, abdomen and external genitalia to see whether your child feels any pain or tenderness in these areas. The doctor will also look for signs of renal artery injury by listening with a stethoscope to the abdomen.

To further evaluate the injuries, the doctor may also run a series of blood and urine tests and various x-rays or other imaging studies such as computerized tomography (CT), intravenous pyelogram (IVP), ultrasound (US), cystogram, retrograde urethrogram (RUG) and/or magnetic resonance imaging(MRI. Based on the results of these tests, the injuries are graded by severity in accordance with injury scales developed by the American Association for the Surgery of Trauma.

Injury to the kidney is most commonly of low grade in the form of either a contusion, hematoma (collection of blood under the capsule of the kidney), or a small laceration of the kidney itself. Patients with this grade of injury are usually managed with rest and observation. The more severe and less commonly occurring injuries of the kidney may require close observation in the hospital and, at times, surgical intervention.

Traumatic injury to the ureter is relatively rare. These injuries are typically managed initially with diversion of the urinary stream while healing is allowed to take place. This may require placement of a temporary drainage tube through the skin (percutaneous) and into either the kidney to divert urine from above and/or into the bladder to drain urine from below the site of injury. In some instances with a more severe injury, initial or delayed surgical intervention may be necessary for definitive management.

Bladder injuries include contusion, which may present with a small amount of blood in the urine requiring no treatment at one extreme of the spectrum, and laceration with rupture of the bladder at the other extreme. Bladder rupture is typically of an intraperitoneal nature, meaning that urine leaks from the bladder into the abdominal cavity. This typically results from a direct blow to the bladder at a time when it is full of urine. These injuries require immediate surgical repair.

Injury to the urethra may be of high grade in the form of a laceration or tear of this delicate tube. This often occurs when the urethra is subjected to shear forces produced by fracture of one or more of the nearby pelvic bones. These injuries are typically managed initially with urinary diversion by a percutaneous bladder tube and then definitively with surgical repair approximately four to six months following the injury. Contusion of the urethra is a less severe injury and may result from a "straddle" mechanism whereby the urethra is compressed against the pubic bone by a hard object such as a bicycle frame. These injuries usually do not require treatment in the acute phase, but with time may result in narrowing (stricture) at the site of previous trauma.

Injury to the external genitalia typically results from a blunt mechanism of trauma. Initial evaluation is critical for defining the presence and extent of injury, and for planning management. This may require evaluation with ultrasound and/or urethrogram and surgical repair of injuries such as lacerations of the skin or testis in boys. Often times, general anesthetic is necessary for optimal evaluation and management, while at the same time minimizing psychological trauma in the female patient.