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Pelvic-fracture urethral injury in children
Judith C Hagedorn1, Bryan B Voelzke1
1Department of Urology, University of Washington Medical Center, Seattle, WA, USA.
Insights
Paediatric posterior urethral injuries from pelvic fractures are rare but serious. Immediate diagnosis and management, followed by reconstructive urology, improve outcomes and reduce complications like strictures.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Reconstructive Urology
Background:
- Pediatric posterior urethral injuries are rare, often resulting from high-impact blunt trauma associated with pelvic fractures.
- The management and long-term complications of these injuries remain controversial due to their low incidence.
Purpose of the Study:
- To review pediatric posterior urethral injuries.
- To discuss current and potential management options for these traumatic injuries.
Main Methods:
- A comprehensive literature search was conducted using PubMed Medline.
- Keywords included 'pediatric', 'pelvic fracture', 'urethral injury', 'stricture', 'trauma', and 'reconstruction' for articles within the last 25 years.
Main Results:
- Most pediatric urethral injuries stem from pelvic fractures due to blunt trauma.
- Initial management involves bladder drainage (suprapubic cystotomy) or urethral realignment, with primary repair an option for girls.
- Delayed urethroplasty yields excellent results for pelvic fracture-associated urethral injuries, despite potential complications like stricture, incontinence, and erectile dysfunction.
Conclusions:
- Traumatic pediatric urethral injuries necessitate prompt diagnosis and management.
- These injuries carry a high complication rate, underscoring the need for close follow-up and expert delayed repair by reconstructive urologists.
Objective:
To review paediatric posterior urethral injuries and the current potential management options; because urethral injury due to pelvic fracture in children is rare and has a low incidence, the management of this type of trauma and its complications remains controversial.
Methods:
We reviewed previous reports identified by searching the PubMed Medline electronic database for clinically relevant articles published in the past 25 years. The search was limited to the keywords 'pediatric', 'pelvic fracture', 'urethral injury', 'stricture', 'trauma' and 'reconstruction'.
Results:
Most paediatric urethral injuries are a result of pelvic fractures after high-impact blunt trauma. After the diagnosis, immediate bladder drainage via a suprapubic cystotomy, or urethral realignment, are the initial management options, except for a possible immediate primary repair in girls. The common complications of pelvic fracture-associated urethral injury include urethral stricture formation, incontinence and erectile dysfunction. Excellent results can be achieved with delayed urethroplasty for pelvic fracture-associated urethral injuries.
Conclusion:
Traumatic injury to the paediatric urethra is rare and calls for an immediate diagnosis and management. These devastating injuries have a high complication rate and therefore a close follow-up is warranted to assure adequate delayed repair by a reconstructive urologist.
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