Does primary urethral realignment improve the outcome of pediatric pelvic fracture urethral injury? A randomized...

Area of Science:

• Pediatric Urology
• Trauma Surgery
• Reconstructive Urology

Background:

• Complete pelvic fracture urethral injury (PFUI) in male children can lead to urethral stenosis.
• Management options include primary urethral realignment or delayed urethroplasty.
• The efficacy of primary urethral realignment in preventing complications is debated.

Purpose of the Study:

• To evaluate the effectiveness of primary urethral realignment in preventing urethral stenosis.
• To determine if primary urethral realignment simplifies delayed urethroplasty after PFUI in male children.

Main Methods:

• A randomized comparative trial involving 40 boys under 18 with complete PFUI.
• Group 1: Primary urethral realignment (n=20).
• Group 2: Suprapubic cystostomy alone (n=20).
• Outcomes assessed included urethral stenosis, defect length, surgical details, and time to normal voiding.

Main Results:

• All patients (100%) who underwent primary realignment developed urethral stenosis and required delayed urethroplasty.
• No significant differences in urethral defect length, intraoperative, or postoperative outcomes between groups.
• Primary realignment group had significantly more procedures and longer time to normal voiding (p<0.001 and p=0.002, respectively).

Conclusions:

• Primary urethral realignment is ineffective in preventing urethral stenosis after complete PFUI in male children.
• It does not simplify subsequent urethroplasty and increases the number of surgical interventions.
• This approach prolongs the overall clinical course for pediatric patients with complete PFUI.