Symphysiotomy: A Viable Approach for Delayed Management of Posterior Urethral Injuries in Children

Basiri, Abbas; Shadpour, Pejman; Moradi, Mohammad‐Taher; AHMADINIA, HOSSEIN; Madaen, Kazem

doi:10.1016/s0022-5347(05)64345-5

Cited by 24 publications

(14 citation statements)

References 12 publications

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“…In children some authors have promoted symphysiotomy as an alternative to the transpubic repair [43]. Symphysiotomy for stricture was initially presented in the 1960s and 1970s but few reports have appeared in the more recent literature.…”

Section: Symphysiotomy For Pelvic Fracture Urethral Distractionsmentioning

confidence: 99%

“…Symphysiotomy is likely to have limited use in adults but it may be useful in children after failed primary repairs, for which most groups advocate pubectomy and subsequent transpubic repair. Basiri et al [43] used the less invasive method of symphysiotomy in two such cases and showed acceptable results. The anterior transpubic approach provides satisfactory access to the prostatomembranous urethra with a reasonable complication rate but it entails a ventral gap in bony pelvis continuity, which may lead to hernia and abnormal gait [44,45].…”

Section: Symphysiotomy For Pelvic Fracture Urethral Distractionsmentioning

confidence: 99%

“…Children have greater skeletal pliability than adults which forms the basis for symphysiotomy. Basiri et al [43] have argued that pubic resection is time-consuming, creates raw surfaces of cancelous bone with bleeding potential and ultimately leaves a gap, through which herniation and limping develop. He advocated symphysiotomy, which is believed to circumvent some of these drawbacks by obviating bone excision.…”

Section: Symphysiotomy For Pelvic Fracture Urethral Distractionsmentioning

confidence: 99%

See 2 more Smart Citations

Post-traumatic urethral strictures in children: What have we learned over the years?

Ranjan

Ansari

Singh

et al. 2012

Journal of Pediatric Urology

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Section: Symphysiotomy For Pelvic Fracture Urethral Distractionsmentioning

confidence: 99%

Section: Symphysiotomy For Pelvic Fracture Urethral Distractionsmentioning

confidence: 99%

Section: Symphysiotomy For Pelvic Fracture Urethral Distractionsmentioning

confidence: 99%

See 1 more Smart Citation

Post-traumatic urethral strictures in children: What have we learned over the years?

Ranjan

Ansari

Singh

et al. 2012

Journal of Pediatric Urology

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“…The disadvantage of this transpubic approach lies in the partial or complete pubectomy needed, which leads to a ventral gap and thus implies an increased risk for hernia and an abnormal foot position [31]. Symphysiotomy, in which the pubic cartilage is transected and forced apart by a retractor, represents an excellent alternative to pubic resection [32]. Deferred treatment should consider the golden triad assuring successful outcome, i.e.…”

Section: Deferred Repairmentioning

confidence: 99%

Diagnosis and Management of Pediatric Urethral Injuries

Pichler¹,

Fritsch

Skradski³

et al. 2012

Urol Int

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Objective: The incidence of urethral injuries in children is rare due to the fact that the urethra is short, mobile and protected by the pubic bone. The management of urethral trauma in childhood remains controversial because of the limited expertise of most urologists. Material and Methods: We performed a literature review by searching the Medline database for articles published between 1975 and 2010 based on clinical relevance. Electronic searches were limited to the keywords ‘pediatric’, ‘urethral injury’, ‘trauma’ and ‘reconstruction’. Results: Retrograde urethrography is considered the gold standard for diagnosis of urethral injuries. The initial management should ensure drainage of the bladder either by suprapubic cystostomy or urethral realignment if possible: in complete anterior urethral disruption as well as in children with life-threatening pelvic and intra-abdominal injuries after posterior urethral injuries, a deferred repair after 3 months is necessary. Immediate primary suturing of disrupted and dislocated urethral ends should be avoided because of high complication rates. Primary repair, however, of the defect is possible in girls avoiding a 2-stage approach. Conclusion: The aim of therapy is minimizing remote damages such as urethrocutaneous fistulae, periurethral diverticulae, strictures, incontinence and impotence with different therapeutic management depending on classification of the injury and the presence of life-threatening injuries.

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“…Basiri et al have described anastomotic urethroplasty after symphysiotomy rather than using a transpubic approach in children. [27]…”

Section: Types Of Pubectomy and Its Role In Urethroplastymentioning

confidence: 99%

Current concepts in the management of pelvic fracture urethral distraction defects

2011

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Objectives:Pelvic fracture urethral distraction defect (PFUDD) may be associated with disabling complications, such as recurrent stricture, urinary incontinence, and erectile dysfunction. In this article we review the current concepts in the evaluation and surgical management of PFUDD, including redo urethroplasty.Materials and Methods:A PubMed™ search was performed using the keywords “pelvic fracture urethral distraction defect, anastomotic urethroplasty, pelvic fracture urethral stricture, pelvic fracture urethral injuries, and redo-urethroplasty.” The search was limited to papers published from 1980 to March 2010 with special focus on those published in the last 15 years. The relevant articles were reviewed with regard to etiology, role of imaging, and the techniques of urethroplasty.Results:Pelvic fracture due to accidents was the most common etiology of PFUDD that usually involved the membranous urethra. Modern cross-sectional imaging, such as sonourethrography and magnetic resonance imaging help assess stricture pathology better, but their precise role in PFUDD management remains undefined. Surgical treatment with perineal anastomotic urethroplasty yields a success rate of more than 90% in most studies. The most important complication of surgical reconstruction is restenosis, occurring in less than 10% cases, most of which can be corrected by a redo anastomotic urethroplasty. The most common complication associated with this condition is erectile dysfunction. Urinary incontinence is a much rarer complication of this surgery in the present day.Conclusions:Anastomotic urethroplasty remains the cornerstone in the management of PFUDD, even in previously failed repairs. Newer innovations are needed to address the problem of erectile dysfunction associated with this condition.

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Symphysiotomy: A Viable Approach for Delayed Management of Posterior Urethral Injuries in Children

Abstract: Symphysiotomy is hereby revisited as a simple and effective approach for repairing traumatic posterior urethral injuries in the pediatric population. It can be performed instead of transpubic urethroplasty to manage long or otherwise complicated strictures.

Cited by 24 publications

References 12 publications

Post-traumatic urethral strictures in children: What have we learned over the years?

Post-traumatic urethral strictures in children: What have we learned over the years?

Diagnosis and Management of Pediatric Urethral Injuries

Current concepts in the management of pelvic fracture urethral distraction defects

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