Posttraumatic complete and partial loss of urethra with pelvic fracture ingirls: An appraisal of management

Purpose: Urethral injury in girls accompanying fracture of the pelvis is ra re. We present our experience with 5 such complex cases and review the lite rature to define the types of problem and determine appropriate management. Materials and Methods: We report on 5 girls with posttraumatic urethral inj uries and pelvic fracture resulting in structure as well as management base d on the site and length of urethral stricture. Associated injuries and res ults are discussed. Results: Of the 5 girls who presented with stricture 4 had undergone suprap ubic cystostomy as initial treatment, whereas in 1 primary repair had faile d. Urethral reconstruction using a bladder flap tube and distal urethrotomy into the vagina were performed in 3 and 1 cases, respectively. These 4 gir ls were continent although 1 required clean intermittent catheterization fo r a short period. The 3 patients with complete urethral loss had a more sev ere degree of pelvic fracture, including 1 treated with core through intern al urethrotomy. Conclusions: Posttraumatic urethral injury accompanying pelvic fracture in young girls results in challenging management situations. More severely dis placed pelvic fracture is associated with greater urethral loss and require s more complex repair. Cases of partial urethral injury or urethral transec tion without much displacement are better managed by primary repair of the transected urethra, which decreases morbidity. Primary repair may not be fe asible in patients with extensive injury, who should be treated with second ary appropriate reconstruction after preliminary suprapubic cystostomy. Com plete urethral loss may be managed by bladder flap tube neourethra creation s with effective continence and excellent outcomes. Short: segment distal u rethral strictures may be treated with meatotomy or core through internal u rethrotomy.