GENITOURINARY TRACT INJURIES IN GIRLS

Objective To evaluate lower genitourinary tract injuries in girls and to propose guidelines for the investigation and initial management of this unusual injury. Patients and methods The hospital records of 38 g irls (aged 2-13 years) treated in our institution because of lower gen itourinary (LG) tract injury between 1988 and 1995 were reviewed retro spectively, Urethral ruptures were detected in six patients, but the m ost frequent injuries were to the vulva (63%) and vagina (53%). There were pelvic fractures in eight patients and femoral fractures in a fur ther five. Eight patients had concomitant anorectal lacerations. Vagin al and perineal lacerations were repaired primarily and a temporary ur ethral catheter was placed for a mean of 3 days. Partial urethral disr uptions were repaired primarily over a stenting catheter in three pati ents, In one case, vaginal laceration and proximal complete rupture of the urethra was managed through a transvaginal approach with end-to-e nd urethral anastomosis over a stenting catheter. There was a complete rupture of the distal urethra and avulsion of the external meatus in two cases and these patients were managed by urethral advancement and meatoplasty, Results Perineal physical signs did not reflect the sever ity of the lesions and cystovaginoscopy allowed localization of lacera tions in some cases. Primary repair was possible in all cases. Three p atients (8%) had wound infection after surgery, One patient had tempor ary urinary incontinence which was managed conservatively and one pati ent had faecal incontinence which needed secondary surgery, Conclusion All female paediatric patients with suspected LG tract injury should undergo examination under anaesthesia to determine the degree of injur y or possible concomitant injury to the urethra, bladder or rectum. Pr imary repair of these injuries is recommended.