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Published on: November 30, 2010
Delayed management of posterior urethral disruption in children
A H Kardar1, T Sundin, S Ahmed
1Department of Surgery, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
Insights
Delayed surgical repair of posterior urethral disruption in children, following initial suprapubic cystostomy, leads to successful outcomes with no strictures and preserved erectile function. Most boys achieved urinary continence post-operatively.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Reconstructive Surgery
Background:
- Total disruption of the posterior urethra is a severe injury in children, often resulting from road traffic accidents.
- Primary management typically involves suprapubic catheterization, with delayed operative treatment being a consideration for complex cases.
Purpose of the Study:
- To evaluate the outcomes of delayed operative treatment for total posterior urethral disruption in pediatric patients.
- To assess the efficacy and safety of delayed urethroplasty in children with severe urethral injuries.
Main Methods:
- A review of 12 boys (aged 3-12 years) who underwent delayed urethroplasty after initial suprapubic catheterization for posterior urethral disruption.
- Surgical techniques included abdominoperineal transpubic urethroplasty (n=11) and perineal anastomotic urethroplasty (n=1).
- Follow-up assessments included voiding cysto-urethrography and evaluation of continence and erectile function.
Main Results:
- All patients demonstrated a wide anastomosis post-operatively on voiding cysto-urethrography.
- No urethral strictures were observed during a follow-up period of 3 to 45 months.
- Eight boys achieved continence, while three experienced incontinence (total, stress, or nocturnal enuresis).
- Erectile function was preserved in all patients who had confirmed erections prior to surgery.
Conclusions:
- Primary suprapubic cystostomy followed by delayed urethroplasty is a successful treatment strategy for posterior urethral disruption in children.
- Delayed operative repair offers favorable functional outcomes, including the absence of strictures and preservation of erectile function.
Objective:
To review the results of delayed operative treatment of total disruption of the posterior urethra in children.
Patients And Methods:
Twelve boys (3-12 years, mean 7.5) with a suprapubic catheter were referred after primary management in other hospitals. All but one had been involved in road traffic accidents. In addition to their urethral injury, they all had pelvic fractures and the majority also had other major associated injuries. Six to 14 months after injury, abdominoperineal transpubic urethroplasty was performed in 11 patients according to Turner-Warwick. In one case a perineal anastomotic urethroplasty was performed.
Results:
After the operation, voiding cysto-urethrography showed a wide anastomosis in all cases. After 3 to 45 months follow-up, there were no strictures. Eight boys were continent, two were totally incontinent, two had stress incontinence and one nocturnal enuresis. All patients with confirmed erections after injury also had erections after their operation.
Conclusion:
Primary suprapubic cystostomy and delayed repair can be used successfully for the treatment of posterior urethral disruption in children.
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