No small slam: increasing incidents of genitourinary injury from toilets and toilet seats


Correspondence: Benjamin N. Breyer, Department of Urology, UCSF, 400 Parnassus Ave Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA.




  • To describe the epidemiology of genitourinary (GU) injury from toilets that present to USA Emergency rooms (ERs).

Materials and Methods

  • The National Electronic Injury Surveillance System (NEISS) is a stratified probability sample of hospital ER visits for USA consumer product-related injuries.
  • NEISS was used to estimate total toilet- and toilet seat-related GU injury for the years 2002–2010, as well as to describe demographics and injury characteristics.
  • Analyses were performed using strata, primary sampling units and sample weights to accommodate the complex sample survey design.
  • Data are reported as national estimates with 95% confidence intervals (CIs) provided.


  • In all, 13 175 (95% CI 10 185–16 165) GU injuries related to toilets presented to ERs during 2002–2010.
  • The most common mechanism involved crush from accidental fall of toilet seat, described in 9011 (68.4%, 95% CI 6907–11 115) cases.
  • Most crush injuries were isolated to the penis (98.1%). Of crush injuries, 81.7% occurred in children aged 2–3 years and 99.3% occurred in the home. Crush injuries increased over the period 2002–2010 (P = 0.017) by ≈100 per year, ending with an estimated 1707 (95% CI 1011–2402) by 2010.
  • Most patients who sustained toilet- and toilet seat-related GU injuries were treated in the ER and then discharged.


  • While penile crush injury related to a toilet seat is an uncommon mechanism of urological injury in children, the number of incidents appears to be rising.
  • These findings support educational efforts and interventions, such as exchange of heavy toilet seats with slow-close toilet seat technology.