Risk factors associated with bladder and urethral injuries in female children with pelvic fractures

Delaney, Kristen; Reddy, Srinivas H.; Dayama, Anand; Stone, Melvin E.; Meltzer, James A.

doi:10.1097/ta.0000000000000947

Cited by 21 publications

(24 citation statements)

References 37 publications

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“…As for children, the skeletally immature pelvis is more plastic and flexible because there is a more percentage of cartilage, a more porous cortical bone, and the pubic symphysis and sacroiliac joints are more elastic [ 1 ], hence the pelvic absorbs higher energy during trauma. Also, girl’s bladder neck and urethra are more vulnerable because the relative higher position in the pelvis [ 2 ], which may explain why the proportion of girls urethral injuries is higher than female adults in the current literature [ 3 ]. Although rare, the management of female pelvic fracture urethral injuries is complex and there is no guideline yet.…”

Section: Discussionmentioning

confidence: 99%

Bladder neck reconstruction in girls’ pelvic fracture bladder neck avulsion and urethral rupture

Jin

Shu

et al. 2020

BMC Urol

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Background Girls’ pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap. Methods We retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients’ trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior ureth roplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children. Results Operation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period. Conclusions Our method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.

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Section: Discussionmentioning

confidence: 99%

Bladder neck reconstruction in girls’ pelvic fracture bladder neck avulsion and urethral rupture

Jin

Shu

et al. 2020

BMC Urol

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“…Reports have noted that initial emergency department assessment can miss this diagnosis in as many as 40% of cases . A recent study from the National Trauma Data Bank found that in girls, urethral injury appears to be most common in the presence of a vaginal laceration, pelvic circle disruption, multiple pelvic fractures or sacral spine injury . Any girl or woman with this combination of injuries should be closely evaluated for urethral injury.…”

Section: Discussionmentioning

confidence: 99%

Female urethral injuries associated with pelvic fracture: a systematic review of the literature

et al. 2017

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To review systematically the literature on female urethral injuries associated with pelvic fracture and to determine the optimum management of this rare injury. Using Meta-analysis of Observational Studies in Epidemiology criteria, we searched the Cochrane, Pubmed and OVID databases for all articles available before 30 June 2016 using the terms 'female pelvic fracture urethroplasty', 'female urethral distraction', 'female pelvic fracture urethral injury' and 'female pelvic fracture urethra girls.' Two authors of this paper independently reviewed the titles, abstracts, and articles in duplicate. We identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review, including 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair; 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar after both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis after delayed repair. Patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair. The optimum management of female urethral distraction defects is based on very-low-quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is haemodynamically stable appears to be optimal.

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“…Delay in identification, diagnosis and appropriate management can lead to increased morbidity for these patients, resulting in complications such as urethral stricture and infection [6]. Other documented complications include pelvic abscess/sepsis, urethrocutaneous fistulae, severe pelvic inflammation, septic shock, peritonitis, necrotising fasciitis, as well as bladder entrapment [6,17,18] Early detection and management of bladder and urethral injuries is thus a vital part in the care of the trauma patient. Unfortunately due to the nature of these presentations this is not always achievable due to prioritisation of life-threatening injuries.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Lower Urinary Tract Injuries in Traumatic Pelvic Fractures

Tsing¹,

Ng²,

Wullschleger³

2017

Med Surg Urol

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Background: Bladder and urethral injuries associated with pelvic fractures are uncommon and are missed at initial assessment in up to 23% of cases. Missed lower urinary tract injuries have a significant impact on patient morbidity, if not identified early. This study aims to associate mechanisms of traumatic pelvic ring fractures with bladder and/or urethral injuries to determine factors that may increase odds of injury.

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Risk factors associated with bladder and urethral injuries in female children with pelvic fractures

Abstract: Prognostic/epidemiologic study, level III.

Cited by 21 publications

References 37 publications

Bladder neck reconstruction in girls’ pelvic fracture bladder neck avulsion and urethral rupture

Bladder neck reconstruction in girls’ pelvic fracture bladder neck avulsion and urethral rupture

Female urethral injuries associated with pelvic fracture: a systematic review of the literature

Risk Factors Associated with Lower Urinary Tract Injuries in Traumatic Pelvic Fractures

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