Review Article
A systematic review of genitourinary injuries arising from rugby and football

https://doi.org/10.1016/j.jpurol.2019.12.019Get rights and content

Summary

Background

Genitourinary injuries in athletes engaging in high-impact sports such as football and rugby may have catastrophic consequences, especially in individuals with pre-existing urologic concerns, such as a solitary kidney.

Objective

To summarize the current literature on football-related or rugby-related genitourinary organ injuries in both adult and pediatric populations in an effort to risk stratify the likelihood of these injuries.

Methods

An independent systematic literature search for records reporting football-related or rugby-related injuries was conducted by a certified librarian and reviewer in March 2019. The search electronic databases included Medline, EMBASE, Scopus, and Web of Science. All studies reporting football-related or rugby-related genitourinary injuries were included.

Results

Twenty-two records (11 research studies, 11 case reports) were identified. In the pediatric population, the reported football-related kidney injuries were 0.1–0.7% of all football-related injuries, 0.07–0.5% of all sports-related injuries, and 1.5–37.5% of all sports-related genitourinary injuries, with incidence ranging from 0.00000084 to 0.0000092 injuries per exposure (five studies). Pediatric football-related testicular injuries were reported to be 0.11% of all football injuries, 0–0.07% of all sports-related injuries, and 0–37.5% of all sports-related genitourinary injuries; injury per exposure was 0.0000092 (four studies). In adults, there was no proportion of genitourinary injuries that could be determined, and football-related kidney injury incidence was 0.000012 injuries per exposure (one study). No adult literature investigated testicular injuries. Eleven case reports were additionally identified. Review of the case reports suggests that patients with previously existing urologic abnormalities such as ureteropelvic junction obstruction may predispose an individual to kidney injuries.

Conclusion

There is little to suggest that those engaged in football or rugby have a significant risk of genitourinary injury; therefore, future guidelines should reflect this.

Introduction

American football (football) and rugby football (rugby) are popular sports across the world. Football is still considered United States of America's (US) favorite sport, and there are more than 1 million high school football players in US alone [1,2]. According to the World Rugby (formerly International Rugby Football Board and International Rugby Board), the international governing body of rugby, there are estimated number of 8.5 million rugby players in the world, with more than 1.5 million players in North America alone [3].

Football-related or rugby-related injuries are commonly reported. Both National Football League and World Rugby both recognize that ongoing efforts are required to reduce incidence of injuries among professional athletes [4,5]. Moreover, football and rugby are also popular in children and adolescents, contributing to a large proportion of pediatric emergency department (ED) visits per year [[6], [7], [8]]. Among potential injuries from contact sports such as football or rugby are head injuries and intra-abdominal injuries with potentially serious consequences [8].

Genitourinary injuries, which may be intra-abdominal, are particularly worrisome in players and family, especially if there is a single functioning kidney [9,10]. Although minor trauma to genitourinary organs is often not life threatening, it is still important to understand the prevalence and nature of such injuries with potential for serious sequelae, including but not limited to hypertension, renal failure, and rarely, infertility [9,11]. The recommendations for children and adolescents with solitary kidneys to participate in contact sports have changed over time, with the last update from the American Academy of Pediatrics being in 2001 leaning toward player participation [10,12,13]. Moreover, in adult professional athletes participating in contact sports, genitourinary injuries may have a significant impact in their careers. As sports and athletes are both evolving over time, it is possible that there may be changes to the observed proportions and severity of injuries. Furthermore, an updated and concurrent summary of available literature describing genitourinary injuries secondary to football or rugby in both adults and children may also be helpful in contributing to future guideline recommendations. Therefore, this systematic review aims to summarize the current literature on football-related or rugby-related pediatric genitourinary organ injuries and to assess whether current concerns regarding genitourinary trauma is actually represented in the current available literature.

Section snippets

Methods

Following registration on PROSPERO (#CRD42019128307), a systematic review was performed in compliance with the PRISMA statement [14]. A methodologist was consulted before proceeding with the review. The authors included records reporting football-related or rugby-related genitourinary injuries. Pediatric population was defined as individuals aged ≤18 years. If identified record included both adult and pediatric populations, the two were separated if possible. If aggregated into a single group

Results

A total of 305 relevant records were identified. After duplicates were removed, a total of 160 records remained. Following screening by two independent reviewers based on title and abstract, 73 records were reviewed for eligibility. As per the study exclusion criteria, the authors excluded 53 documents before final review (Fig. 1). In total, 22 publications were selected to be included in the final review (Table 1) [[16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28],

Discussion

Despite the increasing popularity of football and rugby, there exists small body of literature that report the consequences of football-related or rugby-related injuries. This systematic review identified the current literature on this topic to highlight the likelihood of football-related or rugby-related injuries in both adult and pediatric population. Moreover, it also hopes to inform future guidelines, especially those that may have recommendations regarding contact sports in children and

Conclusion

This systematic review of current literature on football-related or rugby-related genitourinary injuries suggests that it is rare to develop serious genitourinary injury from playing football. There were no studies reporting proportion or incidence of rugby-related injuries. In both adults and children, the few case reports reporting kidney injuries from playing rugby or football often involved unknown pre-existing abnormalities and did not result in serious consequences.

This study affirms

Ethical approval

None sought.

Funding

None declared.

Competing interest

None declared.

References (43)

  • T.D. Simon et al.

    Emergency department visits among pediatric patients for sports-related injury: basic epidemiol-ogy and impact of race/ethnicity and insurance status

    Pediatr Emerg Care

    (2006)
  • K. Psooy

    Sports and the solitary kidney: what parents of a young child with a solitary kidney should know

    Can Urol Assoc J

    (2014)
  • American Academy of Pediatrics: medical conditions affecting sports participation

    Pediatrics

    (2001)
  • A.N. Kulkadia et al.

    Testicular trauma: impact on reproductive function

    J Urol

    (1996)
  • Recommendations for participation in competitive sports

    Pediatrics

    (1988)
  • Medical conditions affecting sports participation. American Academy of pediatrics committee on sports medicine and fitness

    Pediatrics

    (1994)
  • A. Liberati et al.

    The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

    BMJ

    (2009)
  • National Heart, Lung, and Blood Institute. Development and use of quality assessment tools [Internet]....
  • B.K. Johnson et al.

    Epidemiology of chest, rib, thoracic spine, and abdomen injuries among United States high school athletes, 2005/06 to 2013/14

    Clin J Sport Med

    (2017)
  • H.S. Bagga et al.

    Sports-related genitourinary injuries presenting to United States emergency departments

    Urology

    (2015)
  • J.M. Bieniek et al.

    Sports-related testicular injuries and the use of protective equipment among young male athletes

    Urology

    (2014)
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