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Management of ruptured posterior urethra in childhood
Insights
Early suprapubic cystostomy and primary urethral realignment effectively treated pelvic fractures with posterior urethral rupture in boys. Long-term follow-up shows excellent voiding, continence, and sexual function, with successful fertility in some cases.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Reconstructive Urology
Background:
- Pelvic fractures in boys can cause severe posterior urethral injuries.
- Traditional management involves suprapubic cystostomy and urethral realignment.
Purpose of the Study:
- To evaluate the long-term outcomes of early suprapubic cystostomy and primary urethral realignment for posterior urethral rupture in pediatric patients.
- To assess functional results including voiding, continence, sexual function, and fertility.
Main Methods:
- Retrospective analysis of seven boys with pelvic fractures and posterior urethral rupture.
- Management included early suprapubic cystostomy and primary urethral realignment over a catheter.
- Urethral strictures were managed with dilatations or lysis.
Main Results:
- All seven patients achieved excellent voiding function and continence.
- No patients experienced persistent infection.
- All patients remained potent, and three successfully fathered children.
Conclusions:
- Early suprapubic cystostomy and primary urethral realignment is a highly effective treatment for posterior urethral rupture associated with pelvic fractures in boys.
- This approach leads to excellent long-term functional outcomes, including preserved fertility.
Abstract:
Seven boys with fracture(s) of the bony pelvis and associated partial or complete rupture of the posterior urethra were managed by the time-honored technique of early suprapubic cystostomy and concomitant primary realignment of the urethra over a catheter. Of the 4 children who had a functionally significant urethral stricture 3 were cured within a few months by 1 or 2 simple urethral dilatations and 1 by subsequent transperineal lysis of the angulated urethra from its surrounding fibrous tissue. Followup data for 8 to 22 years (mean 14 years) indicate that all 7 patients void with an excellent stream and are continent, free of infection and potent. In fact, 3 of the 4 married boys have fathered children.