Primary Realignment of Posterior Urethral Ruptures in Children

Gündoğdu, Hasan; Tanyel, Feridun Cahit; Büyükpamukçu, Nebìl; Hiçsönmez, Akgün

doi:10.1111/j.1464-410x.1990.tb14839.x

Cited by 15 publications

(7 citation statements)

References 12 publications

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“…Primary realignment and cystostomy was the usual initial approach in the present group in the light of our previous report [1]. As the present study comprised patients who developed strictures, the stricture rate after primary realignment and cystostomy is not in the scope of the study, but all strictures were treated successfully by repeated dilatations or by re‐operation.…”

Section: Discussionmentioning

confidence: 95%

“…Primary realignment defines a catheter ‘railroaded’ across the disrupted urethral ends into the bladder with or without suture anastomosis of the ruptured urethra [1,2]. The rate of stricture formation can reach 65%, similar to primary repairs, but the strictures usually respond well to a short course of urethral dilatations.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior urethral distraction (PUD) is a rare injury in children; posterior urethral stricture, erectile dysfunction and incontinence can occur after treating PUD [1–3]. The treatment of a urethral stricture can take a long time, with various manipulations directed to the lower urinary tract (LUT), e.g.…”

Section: Introductionmentioning

confidence: 99%

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Late urodynamic findings after treating traumatic rupture of the posterior urethra in boys

et al. 2006

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crush injury in two boys. Seven boys had an isolated urethral rupture, two also had a bladder neck injury and two also had a perforated bladder. No gross neurological impairment developed after trauma. Voiding cysto-urethrograms after initial therapy showed vesico-ureteric reflux in five boys, but in only one at the time of the urodynamic studies. At the time of urodynamic study, the mean ( SD ) age of the patients was 15 (6) years; seven were fully continent, one had intermittent leakage, two were incontinent, and one had nocturnal enuresis. CMG-electromyography (EMG) showed a reduced maximum cystometric capacity in nine patients, reduced compliance in 10, stable detrusor in 11, synergic detrusorsphincter activity in 11, and residual urine in one. The uroflowmetry-EMG study showed prolonged voiding time and flow time, decreased maximum flow urinary rate (Q max ) and mean flow rate (Q avg ). The shape of the flow curve showed an uninterrupted low-amplitude pattern.Comparing these patients with age-matched controls, CMG and uroflowmetry studies showed that the maximum cystometric bladder capacity, compliance, Q max and Q avg were all significantly lower in patients with PUD, while voiding time and flow time were significantly higher. CONCLUSIONThe LUT deteriorates after treating PUD in boys. CMG and uroflowmetry findings are consistent with partial anatomical obstruction distal to the bladder. Our results are preliminary and full urodynamics, including pressure-flow studies, will be useful to support this conclusion. A urodynamic study should be integral in the management of PUD.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Late urodynamic findings after treating traumatic rupture of the posterior urethra in boys

et al. 2006

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“…The initial management of children with posterior urethral injuries is one of the most controversial and technically difficult problems in pediatric urology. The controversy in management of the PUI currently surrounds two basically different methods: (i) early SPC (without disturbing retropubic hematoma) followed after 4–6 months by the repair of the inevitable posterior urethral stricture; and (ii) concomitant one‐stage SPC and urethral realignment 5,6 …”

Section: Discussionmentioning

confidence: 99%

The effectiveness of early primary realignment in children with posterior urethral injury

2005

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Aim: The aim of this retrospective study was to compare the results of delayed repair and early primary realignments in patients with posterior urethral injury. Methods : From 1990: From to 2003 children were admitted to the Medical Faculty of Uluday University, Bursa, Turkey, for posterior urethral injuries. Traffic accidents were the most common cause of injury (n = 17). Twelve patients (60%) who were referred early (1-10 days) underwent early realignment over a urethral tube. A total of eight patients (40%) underwent delayed repair using transpubic route. In these patients, surgical repair of the urethra was performed 5-6 months later. Results: Of the 12 patients who underwent early urethral realignment, six required at least one visual internal urethrotomy following the removal of the urethral catheter. Urethral stricture developed in two of 12 patients (16.6%) who underwent early urethral realignment. Of the eight patients who underwent delayed repair, six required at least one visual internal urethrotomy following removal of the urethral catheter. Urethral stricture developed in three of eight patients (37.5%) who underwent delayed repair. This difference was statistically significant (P < 0.05). Conclusion:The urethral stricture in patients who underwent early primary realignment was less developed than the stricture that developed in those who underwent delayed management. According to these results we recommend early primary realignment in children with posterior urethral injury.

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“…[19] studied 12 children with complete rupture of the posterior urethra who underwent primary alignment. Out of these 10 developed strictures and all these patients had problems of continence.…”

Section: Management Of Urethral Traumamentioning

confidence: 99%

Delayed repair is the ideal management for posterior urethral injuries- For the motion

Philipraj

2010

Indian J Urol

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Posterior urethral injuries are seen in trauma cases with pelvic fracture. The time-tested and honored method of management is immediate supra-pubic diversion followed by delayed repair. Immediate alignment as a management option is not new. It was abandoned 30 years ago due to high incidence of incontinence and impotence. However, of late there is a tendency towards immediate management of these injuries with various endoscopic maneuvers. Unfortunately, there is little evidence supporting this. Even these evidences are of limited in number and of limited duration of follow-up.

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Primary Realignment of Posterior Urethral Ruptures in Children

Cited by 15 publications

References 12 publications

Late urodynamic findings after treating traumatic rupture of the posterior urethra in boys

Late urodynamic findings after treating traumatic rupture of the posterior urethra in boys

The effectiveness of early primary realignment in children with posterior urethral injury

Delayed repair is the ideal management for posterior urethral injuries- For the motion

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