Pediatric Bulbar and Posterior Urethral Injuries: Operative Outcomes and Long-Term Follow-Up

Trachta, Jan; Morávek, J; Kříž, Jan; Pádr, Radek; Škába, R

doi:10.1055/s-0035-1566102

Cited by 4 publications

(5 citation statements)

References 15 publications

(21 reference statements)

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“…Perineal BPA can be difficult due to the small and relatively inelastic urethra in children ( 314 , 315 ). A transpubic or perineo-abdominal route is required in 10–42% of children ( 269 , 316 , 317 ). As a result, the success rates for childhood DU (by any technique) are not as good as in those for adults with 62.5–85% 5-year stricture free rates ( 4 , 28 , 133 , 243 , 250 , 269 , 318 , 319 ).…”

Section: Male Children and Pfuimentioning

confidence: 99%

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

Barratt

Bernard

Mundy

et al. 2018

Transl. Androl. Urol.

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Pelvic fracture urethral injury (PFUI) management in male adults and children is controversial. The jury is still out on the best way to manage these injuries in the short and long-term to minimise complications and optimise outcomes. There is also little in the urological literature about pelvic fractures themselves, their causes, grading systems, associated injuries and the mechanism of PFUI. A review of pelvic fracture and male PFUI literature since 1757 was performed to determine pelvic fracture classification, associated injuries and, PFUI classification and management. The outcomes of; suprapubic catheter (SPC) insertion alone, primary open surgical repair (POSR), delayed primary open surgical repair (DPOSR), primary open realignment (POR), primary endoscopic realignment (PER), delayed endoscopic treatment (DET) and delayed urethroplasty (DU) in male adults and children in all major series have been reviewed and collated for rates of restricture (RS), erectile dysfunction (ED) and urinary incontinence (UI). For SPC, POSR, DPOSR, POR, PER, DET and DU; (I) mean RS rate was 97.9%, 53.9%, 18%, 58.3%, 62.0%, 80.2%, 14.4%; (II) mean ED rate was 25.6%, 22.5%, 71%, 37.2%, 23.6%, 31.9%, 12.7%; (III) mean UI rate was 6.7%, 13.6%, 0%, 14.5%, 4.1%, 4.1%, 6.8%; (IV) mean FU in months was 46.3, 29.4, 12, 61, 31.4, 31.8, 54.9. For males with PFUI restricture and new onset ED is lowest following DU whilst UI is lowest following DPOSR. On balance DU offers the best overall outcomes and should be the treatment of choice for PFUI.

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Section: Male Children and Pfuimentioning

confidence: 99%

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

Barratt

Bernard

Mundy

et al. 2018

Transl. Androl. Urol.

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“…Similar to the articles on endoscopic treatments, the definitions of (surgical) treatment success were heterogeneous. In eight of the 15 studies, the authors used relatively objective criteria such as radiographic evidence of urethral patency (11, 13, 19, 21, 25) or no further need of any intervention (11, 15, 17, 24) as a surrogate for success, whereas treatment success was determined rather clinically (absence of urinary symptoms, improvement in uroflowmetry, patient satisfaction, absence of post-void residual urine) in five (12, 14, 16, 18, 23) or was not defined in two studies (20, 22). Roughly 58% of boys undergoing urethroplasty were treated by excision and primary anastomosis, followed by graft augmentation in 12%, flap urethroplasty in 9%, and pull-through urethroplasty in 6%.…”

Section: Urethroplastymentioning

confidence: 99%

Anterior Urethral Strictures in Children: Disease Etiology and Comparative Effectiveness of Endoscopic Treatment vs. Open Surgical Reconstruction

2019

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Pediatric anterior urethral strictures are rare and recommendations regarding treatment strategies derive from small monocentric case series. In 2014, a collaborative effort of the Société Internationale d'Urologie and the International Consultation on Urological Diseases drafted the first systematic and evidence-based guideline for diagnosis and treatment of urethral strictures in children. Against this backdrop, we performed an updated literature review to provide a comprehensive summary of the available evidence and contemporary outcomes with a focus on comparative effectiveness of endoscopic treatment (dilation or urethrotomy) vs. open surgical reconstruction. Overall, 22 articles reporting on children with anterior urethral strictures were included into the review. Most strictures were iatrogenic (48%) and traumatic (34%), whereas congenital (13%), inflammatory (4%), or postinfectious strictures (1%) were rather rare. The cumulative success rate of endoscopic treatment and urethroplasty was 46% (range: 21–75; N = 334) and 84% (range: 25–100; N = 347), respectively. After stratifying patients according to urethroplasty technique, success rates were 82% (range: 25–100; N = 206) for excision and primary anastomosis, 94% (range: 75–100; N = 40) for graft augmentation, 97% (range: 87–100; N = 30) for flap urethroplasty, and 70% (one study; N = 20) for pull-through urethroplasty. In conclusion, endoscopic approaches are rather ineffective in the long-term and open surgical reconstruction via urethroplasty should be preferred to avoid multiple, repetitive interventions. Future research may involve multi-institutional, collaborative, and prospective studies, incorporating well-defined outcome criteria and assessing objective surgical endpoints as well as patient-reported functional outcomes.

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“…They reported three patients with transient stress urinary incontinence that resolved with no intervention. None of the patients reported ongoing LUTS, although they remembered such symptoms early after surgery [21]. Interestingly, the youngest patient of our cohort, who was run over by a truck at the age of 4 years, had several years of frequency and urinary incontinence during school years.…”

Section: Discussionmentioning

confidence: 74%

“…Using International Index of Erectile Function-5 questionnaire, one patient reported mild ED and two reported moderate ED due to penile shortening. Of note in their series, 75% of patients required a secondary intervention after primary urethroplasty, two of the urethral strictures were >5 cm in length, and significant mobilization and partial pubectomy was performed to achieve a tension-free anastomosis contributing to penile shortening [21]. Our survey did not include a specific question about penile length.…”

Section: Discussionmentioning

confidence: 98%

“…This questionnaire specifically excluded pelvic fracture population at the time of validation, and this high ED rate thus needs further verification [20]. Another report on the rate of ED after pediatric urethroplasty is from Trachta et al [21] from Czech Republic in 2016. They reported 4.5year follow-up of eight patients who had urethral trauma and underwent anterior (4) and posterior (4) urethroplasty at the mean age of 12.3 years (range 5e17).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term follow-up of urethral reconstruction for blunt urethral injury at a young age: urinary and sexual quality of life outcomes

Baradaran¹,

McAninch²,

Copp³

et al. 2019

Journal of Pediatric Urology

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Pediatric Bulbar and Posterior Urethral Injuries: Operative Outcomes and Long-Term Follow-Up

Abstract: Delayed end-to-end anastomosis for pediatric urethral injury is a safe operational option. However, high rate of short-term complications and reoperations should be expected. Penile shortening is one of the most severe long-term complications.

Cited by 4 publications

References 15 publications

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

Anterior Urethral Strictures in Children: Disease Etiology and Comparative Effectiveness of Endoscopic Treatment vs. Open Surgical Reconstruction

Long-term follow-up of urethral reconstruction for blunt urethral injury at a young age: urinary and sexual quality of life outcomes

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