Pelvic-fracture urethral injury in children

Hagedorn, Judith C.; Voelzke, Bryan B.

doi:10.1016/j.aju.2014.11.007

Cited by 24 publications

(27 citation statements)

References 39 publications

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“…Pelvic fracture is usually caused by a high‐energy injury, such as a traffic accident or fall from heights, and places patients at risk of associated urethral injury, which is known as PFUI . PFUIs are relatively rare and are much more common in males, because the female urethra is shorter and more mobile than that of a male, and is almost completely protected by the pubic bone . PFUIs can cause urinary outflow obstruction, extravasation and secondary sepsis in the acute setting, and can also result in significant morbidity, such as urethral stenosis, ED and urinary incontinence, which can be associated with lifelong disability .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 PFUIs are relatively rare and are much more common in males, because the female urethra is shorter and more mobile than that of a male, and is almost completely protected by the pubic bone. 3,4 PFUIs can cause urinary outflow obstruction, extravasation and secondary sepsis in the acute setting, and can also result in significant morbidity, such as urethral stenosis, ED and urinary incontinence, which can be associated with lifelong disability. 2,5 Because most patients with PFUIs are young, inappropriate treatment and/or delay in management not only leads to low QOL, but can also negatively influence social productivity.…”

Section: Introductionmentioning

confidence: 99%

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Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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Pelvic fractures from high‐energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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“…Road traffic accident was the most common mechanism of injury, and this finding is supported by previous reports. 7,20,21 VCUG and RUG are the gold standard for the investigation of urethral stricture. 2,22 All of our patients had VCUG and RUG.…”

Section: Discussionmentioning

confidence: 99%

“…6 The clinical presentation of urethral-injured patients may include blood at the urethral meatus with or without haematuria, inability to pass urine and a high-riding prostate on digital rectal examination. 7 There is no established protocol for the management of urethral injuries in children due to the infrequency of these injuries. The management of urethral injuries has remained controversial.…”

Section: Introductionmentioning

confidence: 99%

Urethral injury in children: Experience in a teaching hospital in Enugu, Nigeria

Emeka

Enebe

Nduagubam

2020

Proceedings of Singapore Healthcare

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Background: Urethral injury in children is uncommon, and its treatment is challenging. This study evaluated our experience in the management of urethral injuries in children who presented at the paediatric surgical unit of a teaching hospital in Enugu, Nigeria. Methods: The medical records of patients younger than 15 years old admitted to our centre with urethral injury from January 2008 and December 2017 were reviewed retrospectively. Results: During the period of the study, 11 cases (all male) were managed. The mean age of the patients at presentation was 11 years. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the most injured part of the urethra. All the patients had urethroplasty through the perineal approach. There was 90% success at first instance. One patient required redo urethroplasty. Conclusion: Urethral trauma is associated with considerable morbidity. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the part of the urethra most affected. Transperineal urethroplasty was an effective modality of treatment.

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“…Furthermore, false passages into the bladder neck or fistula development between the torn urethra and the rectum can occur with this treatment modality. Consequently, this line of treatment should be avoided in the case of obliterative membranous urethral distraction defects following pelvic fracture (37, 39).…”

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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Pelvic-fracture urethral injury in children

Cited by 24 publications

References 39 publications

Management of male pelvic fracture urethral injuries: Review and current topics

Management of male pelvic fracture urethral injuries: Review and current topics

Urethral injury in children: Experience in a teaching hospital in Enugu, Nigeria

Traumatic Posterior Urethral Strictures in Children and Adolescents

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