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Published on: January 7, 2019
Diagnosis and management of pediatric urethral injuries
Renate Pichler1, Helga Fritsch, Viktor Skradski
1Department of Urology and Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria. renate.pichler @ i-med.ac.at
Insights
Pediatric urethral injuries are rare but challenging to manage. Delayed surgical repair is often preferred to minimize complications like strictures and fistulas.
Area of Science:
- Pediatric Urology
- Trauma Surgery
Background:
- Urethral injuries in children are uncommon due to anatomical protection.
- Management strategies for pediatric urethral trauma lack consensus among specialists.
Purpose of the Study:
- To review the literature on pediatric urethral injuries.
- To provide guidance on the diagnosis and management of urethral trauma in children.
Main Methods:
- Literature search of Medline database (1975-2010).
- Keywords used: 'pediatric', 'urethral injury', 'trauma', 'reconstruction'.
- Focus on clinical relevance and diagnostic/therapeutic approaches.
Main Results:
- Retrograde urethrography is the gold standard for diagnosis.
- Initial management involves bladder drainage (suprapubic cystostomy or urethral realignment).
- Deferred repair (3 months) is recommended for complete anterior disruptions and posterior injuries with life-threatening conditions; immediate repair is associated with high complication rates. Primary repair is feasible in girls.
Conclusions:
- Therapeutic goals include preventing long-term complications such as fistulas, strictures, incontinence, and impotence.
- Management decisions depend on injury classification and severity.
- Optimal treatment aims to minimize functional deficits and improve outcomes in pediatric urethral trauma.
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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