Management of traumatic urethral injuries in children using different techniques: A case series and review of literature

Ugino, Ricardo Torres da Silveira; Pasqual, Suzane; Farias, Adria Karina; Dias, André; Stratigis, John D.; FALCÃO, BRUNO PINHEIRO; Amarante, Antônio Carlos Moreira; Stegani, Marcelo Marcondes; Agulham, Miguel Ângelo; Fachin, Camila Girardi

doi:10.1016/j.ijscr.2017.08.062

Cited by 6 publications

(2 citation statements)

References 24 publications

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“…Anterior sagittal transrectal approach to the posterior urethra or perineal approach for the bulbar urethra, end-to-end repair or use of buccal mucosal grafts for reconstruction, primary repair versus initial SPC, and delayed repair, the surgeon usually has to individualize the approach. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

The Management of Perineal Trauma in Children

Dandinarasaiah

Radhakrishna

Vepakomma

2022

Journal of Indian Association of Pediatric Surgeons

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Aims: This study aimed to evaluate the outcome of perineal trauma in children and to a define protocol for their management. Methods: It is a retrospective study of children who presented with perineal injury between August 2012 and December 2020. The patients were classified into three groups: Group-1 included children with perineal and genitourinary injuries; Group-2 included patients with perineal and anorectal injuries; and Group-3 included patients with perineal, genitourinary, and anorectal injuries. All patients underwent primary repair. Those with full-thickness anorectal injury underwent an additional covering colostomy, while urethral disruption was initially managed by a diverting suprapubic cystostomy (SPC). Results: A total of 41 patients were studied. Impalement injury ( n = 11; 27%) and sexual abuse ( n = 11; 27%) were the most common mechanisms of injury. Twenty (49%) patients had anorectal injuries with 10 (24%) each of partial-thickness and full-thickness injury. There were 24 (59%) genital injuries and five (12%) urethral injuries. One patient each developed anal and vaginal stenosis, both were managed with dilatation. One patient developed a rectovaginal fistula repaired surgically at a later date. Conclusion: Perineal injuries with resultant anorectal or genital damage require a careful primary survey. Following stabilization, an examination under anesthesia as a set protocol will help determine the treatment strategy. A colostomy is essential in the acute management of severe anorectal injuries to reduce local complications and preserve continence. Urethral injuries may warrant an initial diverting SPC in selected cases.

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Section: Discussionmentioning

confidence: 99%

The Management of Perineal Trauma in Children

Dandinarasaiah

Radhakrishna

Vepakomma

2022

Journal of Indian Association of Pediatric Surgeons

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“…Finally, a 9 year old patient with a PFPUDD was treated with anastomotic urethroplasty via an anterior sagittal approach without splitting the rectum with a good post-operative result though follow-up was only 18 months (54). The author reported “an excellent exposure of the posterior urethra.”…”

Section: Discussionmentioning

confidence: 99%

Traumatic Posterior Urethral Strictures in Children and Adolescents

Podestá

2019

Front. Pediatr.

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Background: Management of partial or complete traumatic urethral disruptions of the posterior urethra in children and adolescents, secondary to pelvic fracture poses a challenge. Controversy exists as to the correct acute treatment of posterior urethral injuries and delayed management of PFPUDDs. We reviewed the urological literature related to the treatment of traumatic posterior urethral injuries and delayed repair of these distraction defects in children and adolescents. Material and Methods: There are few long-term outcomes studies of patients who underwent PFPUDDs repairs in childhood; most reports included few cases with short follow up. We excluded studies in which the cohort of patients was heterogeneous in terms of stricture disease, etiology and location. Results: Primary cystostomy and delayed urethroplasty is the traditional management for PFPUIs. Immediate repair is rarely possible to perform. Realignment of posterior urethral rupture in children is indicated in special situations: (a) concomitant bladder neck tears, (b) associated rectal lacerations, (c) long disruptions of the urethral ends. Before delayed reconstruction ascending urethrography and micturating cystourethrogram along with retrograde and antegrade urethroscopy define site and length of the urethral gap. However, the most accurate evaluation of the characteristics of the distraction defect is made when surgical exposure reveals the complexity of the ruptured urethra. Partial ruptures may be managed with urethral stenting or suprapubic cystostomy, which may result in a patent urethra or a short stricture treated by optical urethrotomy. The gold standard treatment for PFPUDDs in children is deferred excision of pelvic fibrosis and bulbo-prostatic tension-free anastomosis, provided a healthy anterior urethra is present. Timing of delayed repair is at 3 to 4 months after trauma. Some urologists prefer either the perineal access or the transpubic approach to restore urethral continuity in children with PFPUDDs. Substitution urethroplasties are used in children with PFPUDDs, when anastomotic repair can't be achieved due to severe damage of the bulbar urethra. Conclusion: As evidenced in this review the progressive perineo-abdominal partial transpubic anastomotic repair has advantages over the isolated perineal anastomotic approach in patients with “complex” PFPUDD. This approach provides wider exposure and facilitates reconstruction of long or complicated posterior urethral distraction defects

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Urogenital and Perineal Trauma

Chirdan

Sutherland

2020

Pediatric Surgery

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Management of traumatic urethral injuries in children using different techniques: A case series and review of literature

Cited by 6 publications

References 24 publications

The Management of Perineal Trauma in Children

The Management of Perineal Trauma in Children

Traumatic Posterior Urethral Strictures in Children and Adolescents

Urogenital and Perineal Trauma

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