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This new total endoscopic and anal irrigation management approach is a comprehensive, minimally invasive, safe, simple, effective way to achieve most goals when treating these patients by protecting the upper tract, maintaining the bladder at safe pressure and providing a satisfactory social life with satisfactory urine and stool continence.

Objective To review the management of major urethral injury in three girls with fractured pelvis following blunt abdominal trauma. Patients and methods Three girls aged 5 years, 1 year and 3 years sustained major urethral injury in association with fractured pelvis following blunt abdominal trauma. Initial management was undertaken elsewhere. Two girls, with complete loss of the urethra and a closed bladder base, were managed by construction of a neourethra using a flipped anterior bladder‐wall tube. The third patient with extensive perineal soft‐tissue loss and rupture of the bladder neck and urethra had a modified Young‐Dees‐Leadbetter bladder neck reconstruction. All three had an associated vaginal injury which did not require a specific surgical procedure. Results The two girls who underwent construction of a neourethra using a flipped anterior bladder‐wall tube are continent. The first voids normally and the second is managed by clean intermittent catheterization. The patient who underwent bladder neck reconstruction is incontinent and further surgery, possibly a continent diversion, may be necessary. Conclusion Pelvic fracture following blunt abdominal trauma in girls may be associated with major urethral injury, usually with an associated vaginal injury. Surgical ingenuity is required to repair such injuries successfully. In those with complete loss of the urethra, a flipped anterior bladder‐wall tube neourethra is suitable.

Cite as: Can Urol Assoc J 2014;8(1-2):e12-5. http://dx.doi.org/10.5489/cuaj.1263 Published online January 14, 2014. AbstractIntroduction: We evaluate the efficacy of the Peristeen (Coloplast A/S, Kokkedal, Denmark) transanal irrigation (TAI) system, as a stool cleansing mechanism, to gain stool continence in children who need reconstructive bladder surgery and have fecal incontinence. Methods: We prospectively evaluated children with neuropathic bladder and bowel dysfunction who were intended for reconstructive bladder surgery and the Malone antegrade continence enema (MACE) procedure. All patients were started on the Peristeen TAI system at least 3 months before surgery to assess their response. Each patient's bowel function, frequency of using the system, satisfaction (and that of their parents) and diaper independency were evaluated before and after reconstructive surgery. Results: We included 18 patients (11 female, 7 male) who were evaluated from April 2006 to the present. The mean age of the group was 7.6 years (range: 4-15). Fifteen patients (83.3%) showed complete dryness from stools. Of the 15 patients, 8 (53.3%) were able to be diaper-free, while 6 continued wearing diapers due to fear of soiling and 1 due to urinary incontinence. The patients underwent reconstructive bladder surgery and continued to use the Peristeen TAI system with the same results postoperatively. The main limitation of this study is the small number of patients included, although this is a very specific patient group. Conclusion: Our initial results suggest that the Peristeen TAI system is a successful conservative substitute for the MACE procedure in children who require reconstructive bladder surgery.