Immediate Management of Posterior Urethral Disruptions Due to Pelvic Fracture: Therapeutic Alternatives

Abstract

No AccessJournal of UrologyPediatric Urology: Editorial1 Apr 1997Immediate Management of Posterior Urethral Disruptions Due to Pelvic Fracture: Therapeutic Alternatives Miguel L. Podesta, Ricardo Medel, Roberto Castera, and Adolfo Ruarte Miguel L. PodestaMiguel L. Podesta More articles by this author , Ricardo MedelRicardo Medel More articles by this author , Roberto CasteraRoberto Castera More articles by this author , and Adolfo RuarteAdolfo Ruarte More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65016-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We retrospectively reviewed the results of 3 types of initial management of pelvic fracture urethral disruption in children. Materials and Methods: From 1980 to 1994, 35 boys 2 to 15 years old (mean age 8.1) with prostatomembranous urethral disruption were treated, including 17 who also had associated injuries. Immediate treatment included suprapubic cystostomy and delayed urethroplasty in 19 patients (group 1), urethral catheter alignment without traction and concomitant suprapubic cystostomy in 10 (group 2), and primary retropubic anastomotic urethroplasty in 6 (group 3). Results: In all patients in groups 1 and 2 severe urethral obliteration developed. Four group 3 patients (66%) had a stricture at the site of anastomotic repair. After delayed urethroplasty 16 group 1 (84%) and all 10 group 2 patients were continent. However, only 3 group 3 patients (50%) achieved continence. Retrospectively associated bladder neck injury occurred in 5 of the 6 incontinent boys. Erections were observed before and after treatment in all but 3 children. Unstable pelvic ring fractures (type IV) comprised 28% of all pelvic fractures with a high rate of associated injuries. Conclusions: As described, urethral alignment was not beneficial for avoiding urethral obliteration. Therefore we recommend suprapubic cystostomy as the only form of initial treatment in these cases. Urinary incontinence seems more likely related to associated bladder neck rupture and the severity of pelvic fracture rather than to initial treatment or delayed urethral repair. Consequently, when associated bladder neck injury is present, we advocate immediate surgical repair. References 1 : Abdominopelvic injury associated with pelvic fracture. J. Amer. Coll. Emerg. Phys.1979; 8: 312. Google Scholar 2 : Urological injuries associated with pelvic fractures. J. Trauma1969; 9: 479. Google Scholar 3 : Genitourinary trauma in the pediatric patient. Urology1993; 42: 563. Google Scholar 4 : Reconstruction of the male urethra instrictures. Acta Chir. Scand.1953; : 176. 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Google Scholar From the Urology Unit, Department of Surgery, Hospital de Ninos Ricardo Gutierrez, Associated Hospital to the University of Buenos Aires, Buenos Aires, Argentina© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byZou Q, Zhou S, Zhang K, Yang R and Fu Q (2017) The Immediate Management of Pelvic Fracture Urethral Injury—Endoscopic Realignment or Cystostomy?Journal of Urology, VOL. 198, NO. 4, (869-874), Online publication date: 1-Oct-2017.KORAITIM M (2018) PELVIC FRACTURE URETHRAL INJURIES: THE UNRESOLVED CONTROVERSYJournal of Urology, VOL. 161, NO. 5, (1433-1441), Online publication date: 1-May-1999.PODESTA M (2018) USE OF THE PERINEAL AND PERINEAL-ABDOMINAL (TRANSPUBIC) APPROACH FOR DELAYED MANAGEMENT OF PELVIC FRACTURE URETHRAL OBLITERATIVE STRICTURES IN CHILDREN: LONG-TERM OUTCOMEJournal of Urology, VOL. 160, NO. 1, (160-164), Online publication date: 1-Jul-1998. Volume 157 Issue 4 April 1997 Page: 1444-1448 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.Metrics Author Information Miguel L. Podesta More articles by this author Ricardo Medel More articles by this author Roberto Castera More articles by this author Adolfo Ruarte More articles by this author Expand All Advertisement PDF downloadLoading ...