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Management of traumatic urethral disruption in children: Oman experience, 1988-2000
Manasvi Upadhyaya1, Neill V Freeman
1Department of Paediatric Surgery, Royal Hospital, Muscat, Sultanate of Oman.
Insights
Primary repair of traumatic urethral disruptions in children is recommended. This approach requires less hospitalization and shorter catheterization times compared to other methods, offering better outcomes for pediatric patients.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Reconstructive Surgery
Background:
- Pediatric urethral disruptions present unique anatomical challenges compared to adults.
- Management of traumatic urethral rupture in children lacks a consensus on optimal treatment.
- Posterior urethral injuries in children can occur at any level due to anatomical differences.
Purpose of the Study:
- To evaluate the outcomes of different surgical management strategies for traumatic urethral disruptions in children.
- To compare primary repair versus delayed repair for posterior urethral disruptions.
- To assess the efficacy of primary alignment for anterior and partial posterior urethral disruptions.
Main Methods:
- Retrospective analysis of 21 pediatric urethral disruption cases over 12 years.
- Detailed follow-up of 20 patients, including 14 posterior and 6 anterior injuries.
- Surgical interventions included trans-symphyseal urethroplasty (early and delayed) and primary alignment.
Main Results:
- Early primary repairs (within 7 days) for complete posterior disruptions showed fewer complications.
- Strictures developed in some early and delayed repairs, requiring interventions like dilatations or urethrotomy.
- Primary alignment for partial posterior and anterior disruptions had a higher stricture rate (4 out of 9).
Conclusions:
- Primary repair of traumatic urethral disruptions in children is associated with shorter hospitalization and catheterization durations.
- The study recommends primary repair for complete posterior urethral disruptions in pediatric patients.
- While primary repairs are favored, complications like strictures and incontinence necessitate careful monitoring and potential further interventions.
Background:
Traumatic urethral disruptions in children differ anatomically from those of adults. In children, the posterior urethra is not protected by the prostate and may be injured at any level. The management of traumatic rupture of the urethra still a matter of debate, and there is no agreement as to which is the best of 3 options.
Methods:
This was a retrospective analysis. Over a 12-year period the authors dealt with 21 urethral disruptions. The authors had detailed follow-up of 20 patients (14 posterior and 6 anterior). Trans-symphyseal urethroplasty (6 early primary repairs and 3 delayed repairs) for complete posterior urethral disruptions was performed. The early repairs were carried out within 7 days of the injury. Primary alignment was performed for 3 of the 4 partial ruptures of the posterior urethra and for all 6 anterior urethral disruptions. Postoperatively, the patients were evaluated for incontinence, penile erectile dysfunction, and stricture formation.
Results:
In one of the early repairs a stricture developed that responded to dilatations. A second patient with bladder neck injury had incontinence after the repair. She underwent a urethral lengthening procedure and still has stress incontinence. Erections were observed in all 4 boys. One of the delayed repairs developed a stricture postoperatively. Of the 9 partial ruptures (6 anterior and 3 posterior) that underwent primary alignment, 4 had strictures. Some of these strictures required up to 5 dilatations or internal urethrotomy for cure. One patient with complete rupture underwent primary alignment, which broke down, and a long stricture developed. This patient is still awaiting a delayed repair. One posterior partial rupture, repaired primarily at another hospital, had a stricture and an urethrocutaneous fistula that responded to curettage and dilatations.
Conclusions:
Primary repairs required less hospitalization and a shorter duration of indwelling catheters. In light of this experience the authors recommend a primary repair in patients with complete posterior urethral disruptions.