Symphysiotomy: A Viable Approach for Delayed Management of Posterior Urethral Injuries in Children

Basiri, Abbas; Shadpour, Pejman; Moradi, Mahmoudreza; AHMADINIA, HOSSEIN; Madaen, Kazem

doi:10.1097/00005392-200211000-00088

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…At surgical reconstruction through longitudinal abdominal approach, the bladder and vagina were exposed extraperitoneally with separation of symphysis pubis to confirm previous findings 2 . Muscular tissue of the urethral sphincter was not identified.…”

Section: Case Reportmentioning

confidence: 63%

Construction of Neourethra Using Flipped Anterior Bladder Wall Tube in a Prepubertal Girl with Complete Disruption of Urethra

Mitsui

Tanaka

Moriya

et al. 2010

Urology

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A rare case of urethral construction using flipped anterior bladder wall tube in 8 year-old girl with complete disruption of the urethra and vagina accompanying pelvic fracture was reported. Following a split of the pubic symphysis, the vagina was reconstructed with end-to-end anastomosis. The neourethra was constructed tubularizing and flipping anterior bladder wall flap caudally to proximal site of the original urethra after fascial sling procedure. After catheter removal, this girl has been continent and voided normally. In conclusion, flipped anterior bladder wall tube technique for urethral construction is suitable in prepubertal girls with complete disruption of the urethra.1

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Section: Case Reportmentioning

confidence: 63%

Construction of Neourethra Using Flipped Anterior Bladder Wall Tube in a Prepubertal Girl with Complete Disruption of Urethra

Mitsui

Tanaka

Moriya

et al. 2010

Urology

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“…Das et al [15] operated on 10 children using transpubic approach with 100% success rate. Basiri et al [16] reported symphysiotomy in 10 children (both boys and girls); all were successful and continent without any complications. Podesta and Podesta [17] did a comparative study of perineal vs transpubic urethroplasty for traumatic posterior urethral distraction defect in children and found a stricture-free rate of 84% for the perineal approach and 100% in those who underwent transpubic urethroplasty.…”

Section: Discussionmentioning

confidence: 98%

Outcome of anastomotic urethroplasty in traumatic stricture (distraction defect) of posterior urethra in boys

Zafar¹,

Hayat²,

Amin³

et al. 2020

Arab Journal of Urology

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Objective To report the outcomes of operative management of traumatic posterior urethral distraction defect in boys at our Centre, as traumatic posterior urethral stricture in children is a rare condition that presents a major surgical challenge to the paediatric urologist and consensus on the optimal treatment of these strictures in children has not been reached. Patients and methods We retrospectively analysed our data from July 2013 to June 2018. All boys aged ≤16 years with traumatic posterior bulbo-prostatic obliteration (distraction defect) were included. Initial suprapubic cystostomy and delayed definite anastomotic urethroplasty was done in all the boys. The boys were evaluated preoperatively with a retrograde urethrogram and simultaneous voiding cystourethrogram, as well as cystourethroscopy. Results A total of 38 boys, with posterior urethral distraction defect, were divided into primary and redo surgery groups. The primary group comprised 34 boys who were operated upon for the first time. A perineal approach with development of an inter-crural space was done in 12 boys and along with an inferior pubectomy in 19 boys. Three boys in the primary group needed a transpubic approach due to a longer defect. In the redo group, there were six boys, of which four were operated initially outside our hospital, while two were our own unsuccessful urethroplasties. In the redo group, a perineal approach with inferior pubectomy was done in two boys and a transpubic urethroplasty in the remaining four boys. The success rate of anastomotic urethroplasty without any ancillary procedures was 81.5% (strict criterion), while the overall success rate was 94.7% (permissible criterion, which included boys who were managed later with direct vision internal urethrotomy and dilatation). Conclusion The ideal treatment of post-traumatic posterior urethral defect/strictures in boys is tension-free bulbo-prostatic anastomosis. This was done using a transperineal approach in most of the boys, but a few required a transpubic approach, with good results. Abbreviations DVIU: direct vision internal urethrotomy; SPC: suprapubic cystostomy; SUI: stress urinary incontinence

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“…Of the 23 patients with incontinence after delayed urethral repair, four patients (17%) had nocturnal incontinence alone [33,35]. In two of 23 cases (9%), SUI resolved spontaneously at 4 weeks and 6 months, respectively [36,38]. Two of 23 patients (9%) were managed with selfintermittent catheterization for incontinence [33,39].…”

Section: All Patients Undergoing Delayed Repair Required Either An Abmentioning

confidence: 99%

“…Five of 23 patients (22%) underwent surgery for SUI with either an artificial urinary sphincter or fascial sling [4,40,41]. Ten of 23 patients (43%) had persistent SUI at a follow-ups ranging from 4 months to 6 years [3,14,[37][38][39].…”

Section: All Patients Undergoing Delayed Repair Required Either An Abmentioning

confidence: 99%

Female urethral injuries associated with pelvic fracture: a systematic review of the literature

et al. 2017

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To review systematically the literature on female urethral injuries associated with pelvic fracture and to determine the optimum management of this rare injury. Using Meta-analysis of Observational Studies in Epidemiology criteria, we searched the Cochrane, Pubmed and OVID databases for all articles available before 30 June 2016 using the terms 'female pelvic fracture urethroplasty', 'female urethral distraction', 'female pelvic fracture urethral injury' and 'female pelvic fracture urethra girls.' Two authors of this paper independently reviewed the titles, abstracts, and articles in duplicate. We identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review, including 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair; 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar after both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis after delayed repair. Patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair. The optimum management of female urethral distraction defects is based on very-low-quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is haemodynamically stable appears to be optimal.

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Symphysiotomy: A Viable Approach for Delayed Management of Posterior Urethral Injuries in Children

Abstract: Symphysiotomy is hereby revisited as a simple and effective approach for repairing traumatic posterior urethral injuries in the pediatric population. It can be performed instead of transpubic urethroplasty to manage long or otherwise complicated strictures.

Cited by 4 publications

References 12 publications

Construction of Neourethra Using Flipped Anterior Bladder Wall Tube in a Prepubertal Girl with Complete Disruption of Urethra

Construction of Neourethra Using Flipped Anterior Bladder Wall Tube in a Prepubertal Girl with Complete Disruption of Urethra

Outcome of anastomotic urethroplasty in traumatic stricture (distraction defect) of posterior urethra in boys

Female urethral injuries associated with pelvic fracture: a systematic review of the literature

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