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Noniatrogenic Urethral Trauma in Children: A Narrative Review
Rianne J M Lammers1, Tudor Enache2, Sebastien Faraj3
1Department of Urology, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Pediatric urethral trauma research is limited by poor quality and inconsistent reporting. Future studies need standardized definitions and long-term follow-up for reliable treatment and outcome data in children.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Systematic Review
Background:
- Pediatric urethral trauma management often relies on adult data due to limited specific evidence.
- Accidental urethral injuries in children are rare but require effective treatment strategies.
Purpose of the Study:
- To systematically review management strategies and outcomes for pediatric urethral trauma.
- To evaluate the quality of existing literature on pediatric urethral trauma.
Main Methods:
- Systematic literature review following PRISMA guidelines.
- Inclusion of 31 studies published since 1990 with at least five pediatric patients and 3-month follow-up.
- Assessment of methodological quality using the Methodological Index for Nonrandomized Studies (MINORS) tool.
Main Results:
- Evidence quality was low, characterized by retrospective single-center cohorts and inconsistent reporting.
- Open reconstruction was more common than endoscopic management.
- Overall stricture rate was approximately 20%; continence and sexual function outcomes were generally favorable, but data on repeat surgery and quality of life were insufficient.
Conclusions:
- The literature on pediatric urethral trauma suffers from poor quality and inconsistency.
- Recommendations are provided for future research, emphasizing standardized definitions, validated outcome measures, and consistent long-term follow-up.
Background And Objective:
Pediatric urethral trauma is rare, and treatment recommendations are often extrapolated from evidence for adults. We conducted a systematic review of the literature to evaluate management strategies, outcomes, and the quality of reporting for pediatric urethral trauma.
Methods:
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 31 relevant studies published since 1990. Studies were eligible for inclusions if they reported results for five or more patients with at least 3 mo of follow-up for noniatrogenic urethral trauma. Methodological quality was assessed using the Methodological Index for Nonrandomized Studies (MINORS) tool.
Key Findings And Limitations:
The quality of evidence was low: most studies were retrospective single-center cohorts and there was inconsistent reporting of management and outcomes. Open reconstruction was reported more frequently than endoscopic management. Across treatment modalities, the overall stricture rate was ∼20%. Continence and sexual function outcomes were generally favorable. However, data on repeat surgery and quality of life were insufficient for firm conclusions.
Conclusions And Clinical Implications:
The most striking finding from our review is the poor quality and inconsistency of the literature on pediatric urethral trauma. As well as summarizing the outcome data available, we provide a table of recommendations for improving future studies, including the use of standardized definitions, validated pediatric patient-reported outcome measures, and consistent long-term follow-up.
Patient Summary:
We looked at the evidence on treatments and outcomes after accidental damage to the urethra in children. No definitive conclusions can be drawn because the quality of the research is low and inconsistent. We provide advice for future research.
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