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Childhood urethral injuries: perspectives on outcome and treatment
1Department of Urology, University of California School of Medicine, San Francisco.
Insights
Childhood urethral injuries in males can lead to long-term issues like strictures. However, surgical intervention often results in continence and normal voiding, with good outcomes for pediatric urethral injury patients.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Urologic Reconstruction
Background:
- Childhood urethral injuries are uncommon but can have significant long-term consequences.
- Understanding the natural history and treatment outcomes is crucial for pediatric urologists.
Purpose of the Study:
- To review the long-term outcomes of childhood urethral injuries in male patients.
- To compare outcomes between patients requiring adult surgical intervention for strictures and those needing acute management for posterior urethral disruption.
Main Methods:
- Retrospective review of 19 male patients with a history of urethral injury during childhood.
- Patients were divided into two groups: those treated surgically in adulthood and those requiring acute cystostomy drainage for posterior urethral disruption.
- Follow-up assessed continence, voiding function, and sexual function.
Main Results:
- Group 1 (adult surgery for strictures, n=12) developed bulbar urethral strictures and achieved continence and normal voiding, with no impotence.
- Group 2 (acute intervention for posterior disruption, n=7) underwent delayed reconstruction; 6 had good outcomes, but 1 required repeat surgery.
- One patient in Group 2 experienced permanent impotence.
Conclusions:
- Childhood urethral injuries, particularly those leading to bulbar strictures, can be successfully managed with delayed surgical intervention, preserving function.
- Acute management of posterior urethral disruption in children can yield good results, though complications like impotence are possible.
- Long-term follow-up is essential to evaluate the functional outcomes of childhood urethral injuries.
Abstract:
To elucidate the history of childhood urethral injuries, we undertook a retrospective review of 19 male patients comprising 2 groups: those requiring surgical intervention in adulthood and those with complete disruption of the posterior urethra requiring acute intervention (cystostomy drainage). Group 1 patients (n = 12) ranged in age from 17 to 63 years, had sustained urethral injury between the ages of 3 to 15 years and underwent initial surgery from 9 to 18 years after injury. In all 12 patients the strictures developed in the bulbar urethra. All now report continence and normal voiding and none is impotent. Group 2 patients (n = 7) ranged in age from 4 to 16 years and underwent delayed primary reconstruction of the urethral rupture defect. Six patients are now continent with a good stream but the seventh has required repeat optical urethrotomy. One patient with erectile capability at the time of injury was rendered impotent and remains so.