The effectiveness of early primary realignment in children with posterior urethral injury

Abstract

Aim: The aim of this retrospective study was to compare the results of delayed repair and early primary realignments in patients with posterior urethral injury. Methods : From 1990: From to 2003 children were admitted to the Medical Faculty of Uluday University, Bursa, Turkey, for posterior urethral injuries. Traffic accidents were the most common cause of injury (n = 17). Twelve patients (60%) who were referred early (1-10 days) underwent early realignment over a urethral tube. A total of eight patients (40%) underwent delayed repair using transpubic route. In these patients, surgical repair of the urethra was performed 5-6 months later. Results: Of the 12 patients who underwent early urethral realignment, six required at least one visual internal urethrotomy following the removal of the urethral catheter. Urethral stricture developed in two of 12 patients (16.6%) who underwent early urethral realignment. Of the eight patients who underwent delayed repair, six required at least one visual internal urethrotomy following removal of the urethral catheter. Urethral stricture developed in three of eight patients (37.5%) who underwent delayed repair. This difference was statistically significant (P < 0.05). Conclusion:The urethral stricture in patients who underwent early primary realignment was less developed than the stricture that developed in those who underwent delayed management. According to these results we recommend early primary realignment in children with posterior urethral injury.

Urotrauma: AUA Guideline

“…Patients undergoing PR of PFUI may have less severe urethral strictures when compared to patients undergoing SP diversion alone. 23,24 …”

Pediatric Bulbar and Posterior Urethral Injuries: Operative Outcomes and Long-Term Follow-Up

“…1,4,[9][10][11][12][13] Concerning the timing of the operation, there is increasing evidence in the literature that immediate realignment of lacerated urethra is possible (provided that the patient is stable and the surgeon experienced) and has lower rate of postoperative strictures compared with delayed end-to-end anastomosis while the rate of incontinence and ED stays the same. [14][15][16] Despite this possible advantage of early realignment, we believe that delayed urethral anastomosis is safer for the severely injured patient and gives more time to the surgeon to plan not only the operation itself but also preoperative imaging. Well-planned imaging may also include pelvic MRI that is available in all pediatric centers today when necessary.…”

Our experience, technique and long-term outcomes in the management of posterior urethral strictures

“…Traditionally, many surgeons have prohibited immediate surgical management in children, thinking that any attempt to evacuate the pelvic hematoma may trigger more bleeding and result in greater injury to the pelvic nerves and vessels. Balkan et al [4] compared the results of repair of posterior urethral injury in children managed by delayed repair versus early realignment, and they concluded that urethral stricture in patients who underwent early realignment was less developed than in those who underwent delayed repair. Nerh et al [5] reported their long-term follow up of 22 children and documented that immediate urethral realignment in children should be attempted to prevent long-term complications.…”