Common Pediatric Urology Sports Injuries

By Dr. Edwin A. Smith, M.D., F.A.A.P., F.A.C.S.

Sports are a great way for kids to work on their physical health while also learning important lessons about community, commitment, and responsibility. However, sometimes injuries related to these sports are unavoidable. Issues like concussions and orthopedic injuries are commonly discussed, but did you know there are also very serious urological injuries young athletes can experience? To help you and your children prepare in case the worst happens, we’re discussing common pediatric urological injuries from popular children’s sports.

How Common Are Sports-Related Genitourinary (GU) Injuries?

Genitourinary trauma includes injuries to the kidneys, bladder, and genitals (testes, vagina, and penis) is reported to represent an important 10% of all pediatric traumas. Notably, emergency room and hospital-based national injury and trauma registries have identified sporting injury as the cause of one-third of genitourinary injuries in children thereby making it the most common cause of pediatric GU injury. Trauma registries may actually underestimate the real number of injuries because they do not include less serious injuries treated in outpatient clinics and physician’s offices.

What Sports Activities Are Most Likely to Produce Genitourinary Trauma in Pediatric Patients?

Involvement in sports activities can be an important part of a child’s development. Knowing which activities are more likely to be associated with injuries helps parents and children become more aware and take proper precautions while still enjoying sports participation. For instance, one-third of genitourinary sports-related injuries occur with bicycling making it the most common activity associated with genitourinary injury. The majority of kids enjoy bike riding so it is not surprising that this activity tops the list. Also, the riskier form of biking including off-road biking and extreme sport biking are becoming more popular.

Injuries related to team sports such as football, baseball or softball, basketball, soccer, and lacrosse are also common, particularly among boys, and combined these activities represent another third of all injuries. Kicks to the groin, helmet contact, or the impact of a fast-moving ball as with baseball or lacrosse can cause serious damage to the testicles. The most serious injuries to the testis occur when the testis is hammered against the pubic bone resulting in a contusion, bleeding inside the scrotum, fracture or rupture of the testis. Some injuries may not be correctable and may result in loss of a testicle. Fortunately, most patients that sustain injuries with team sports are evaluated and treated in the ED without inpatient admission.

How Can Common Pediatric Urology Sports Injuries be Avoided?

Genitourinary injuries from bicycles are usually from falls or straddle injuries and most bike injuries occur from collisions with the “top bar” or the handlebar. Using a properly fitted bike, properly padded seats, padded top bar and attention to speed and surroundings will lessen the likelihood of jury.

Boy athletes that are participating in contact sports including football, soccer, baseball, basketball, lacrosse, and hockey should wear an athletic cup made of hard plastic or metal. Boys should begin to wear a cup as soon as they are big enough for one to fit – usually around age 6 to 8. Proper fit is crucial and the cup must be held in proper position by an athletic supporter, jock strap or compression shorts designed to be fitted with a cup. The cup should fit firmly against the body and not shift out of place during activity. If your son is involved in a non-contact sport that involves lots of running, a jock strap or compression shorts without a cup are sufficient and will help keep the penis and scrotum up and out of the way. If you are uncertain what your son should be using, ask a knowledgeable coach or athletic trainer.

What are the Signs and Symptoms of Common Pediatric Urology Sports Injuries?

Blood in the urine or at the opening of the urethra, inability to urinate, flank or abdominal pain, or swelling, bruising and tenderness of the external genitalia usually accompany genitourinary injury. To reduce the morbidity of the injury it is important to quickly identify and properly manage genitourinary injuries. If an injury has occurred there should not be any delay in getting medical attention for your child. Imaging with X-rays, ultrasound, CT may be necessary to fully assess an injury. While most injuries are managed with monitoring and supportive care and only a few with surgical treatment the determination of the best treatment can only be made after careful evaluation.

Special Circumstances: Can My Child Who Has a Solitary Kidney or Testis Still Participate in Contact Sports?

Yes, boys with a single testicle or a history of an undescended testicle can participate in contact sports if they wear a protective cup. For children with chronic kidney disease or a solitary kidney, the current policy statement by the American Academy of Pediatrics is a “qualified yes”. This recommendation stems from the recognition that kidney injuries during contact sports are uncommon and catastrophic kidney injuries are even rarer. However, parents of children with kidney problems or solitary GU organs should carefully consider the risks and benefits of their child’s participation in a contact sport and make an informed decision only after consulting with their child’s pediatrician and urologist.

If you have any more questions or concerns about common pediatric urology sports injuries, click here to schedule an appointment with an expert Georgia Urology pediatric urologist.