Urethral injury in girls with fractured pelvis following blunt abdominal trauma

Abstract

Objective To review the management of major urethral injury in three girls with fractured pelvis following blunt abdominal trauma. Patients and methods Three girls aged 5 years, 1 year and 3 years sustained major urethral injury in association with fractured pelvis following blunt abdominal trauma. Initial management was undertaken elsewhere. Two girls, with complete loss of the urethra and a closed bladder base, were managed by construction of a neourethra using a flipped anterior bladder‐wall tube. The third patient with extensive perineal soft‐tissue loss and rupture of the bladder neck and urethra had a modified Young‐Dees‐Leadbetter bladder neck reconstruction. All three had an associated vaginal injury which did not require a specific surgical procedure. Results The two girls who underwent construction of a neourethra using a flipped anterior bladder‐wall tube are continent. The first voids normally and the second is managed by clean intermittent catheterization. The patient who underwent bladder neck reconstruction is incontinent and further surgery, possibly a continent diversion, may be necessary. Conclusion Pelvic fracture following blunt abdominal trauma in girls may be associated with major urethral injury, usually with an associated vaginal injury. Surgical ingenuity is required to repair such injuries successfully. In those with complete loss of the urethra, a flipped anterior bladder‐wall tube neourethra is suitable.

Use of Pedicle Flap from the Labia minora for the Repair of Female Urethral Strictures

“…They combined a fascial pubovaginal sling in 41 patients, a modified Per- Tanello/Frego/Simeone/Cunico eyra procedure in 5 patients, and a Kelly plication in 1 case; continence was obtained globally in 42 subjects. Ahmed and Neel [4] treated 3 young girls (average age 3 years) with major urethral injury following a blunt trauma with fractured pelvis. Two girls with complete loss of the urethra and a close bladder base underwent a reconstruction of a neourethra using a flipped anterior bladder wall tube.…”

Construction of a neourethra in girls: follow-up results

“…Rarely, there may be complete loss of the urethra after such an injury [2,6,7]. Urethrovaginal injuries may also be secondary to urologic instrumentation, operative trauma, and obstetric complications [4].…”

“…Urethrovaginal injuries may also be secondary to urologic instrumentation, operative trauma, and obstetric complications [4]. Whereas primary repair of the injured female urethra may be undertaken, delayed repair is recommended when there is complete loss of the urethra or severe damage to the bladder neck and urethra [2,5]. Construction of a neourethra using the FABWT is very suitable for such cases [1,2].…”

“…All ®ve patients underwent construction of a neourethra using a FABWT, a technique described and illustrated in previous publications [1,2]. Repair of the vagina was required in two cases.…”

“…The majority of published reports deal with boys, although girls are also at risk [2,3,7]. Female urethral injuries may be associated with serious morbidity with loss of the entire urethra in some cases, where urethral reconstruction may be necessary [2]. We reviewed the results after construction of a neourethra using the¯ipped anterior bladder-wall tube (FABWT) technique [1].…”