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Long-term outcome of posterior urethral rupture in boys: a comparison of different surgical modalities
Abdurrahman Onen1, Hayrettin Oztürk, Mete Kaya
1Department of Pediatric Surgery, Dicle University School of Medicine, Diyarbakir, Turkey. aonenmd@hotmail.com
Insights
Long-term outcomes for posterior urethral rupture in children show that surgical treatments have similar complication rates. Individualized treatment plans are crucial for managing urethral injuries from pelvic trauma.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Reconstructive Urology
Background:
- Posterior urethral rupture is a severe complication of pelvic trauma in children.
- Management strategies aim to restore urethral continuity and function while minimizing long-term morbidity.
Purpose of the Study:
- To evaluate the long-term urologic outcomes in children treated for posterior urethral rupture.
- To compare the effectiveness and complication rates of different surgical approaches.
Main Methods:
- Retrospective review of 49 pediatric patients with posterior urethral rupture (1986-2000).
- Long-term urologic evaluation included physical examination, imaging (ultrasonography, urethrography), and functional assessments (voiding, continence, erectile function, semen analysis).
- Surgical interventions included primary realignment, immediate repair, and delayed repair.
Main Results:
- Mean follow-up was 12 years.
- Urethral continuity achieved in 97.9% of patients; 61.2% were symptom-free.
- Long-term complications were higher with prostatic urethra injuries but similar across the three surgical procedures.
Conclusions:
- Surgical treatments for posterior urethral rupture, except for partial injuries, present similar complication rates and long-term morbidity.
- Individualized treatment selection is essential, considering injury extent, patient stability, and associated injuries.
Objectives:
To evaluate the long-term outcome of posterior urethral rupture due to pelvic trauma.
Methods:
We retrospectively reviewed the records of 49 children with posterior urethral rupture from 1986 to 2000. The urologic evaluation at the last follow-up visit was made by the same surgeon and included physical examination, ultrasonography, simultaneous retrograde urethrography, and voiding cystourethrography, as well as cystourethroscopy in some cases. The long-term urologic results were determined by voiding function, continence and erectile function, and semen analysis.
Results:
The mean follow-up was 12 years (range 4 to 17). The average age was 8 years at the time of trauma and 20 years at the last follow-up visit. Primary realignment (22 patients), immediate repair (8), and delayed repair (16) were performed for posterior urethral rupture. Urethral continuity was achieved in 97.9% of patients, and 30 (61.2%) were free of symptoms. The overall rate of long-term complications was significantly greater in patients with a prostatic urethra location injury, and it was similar for the three surgical procedures.
Conclusions:
The results of our study have shown that, apart from partial injury, all types of surgical treatment are equally problematic, with similar complication rates and long-term morbidity. The procedure of choice should be individualized, depending on the anatomy and the extent of the urethral injury, stability of the patient, and presence of additional injuries.
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