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. 2016 Apr;8(Suppl 2):S116–S118.

Urinary Tract Trauma in Children

PMCID: PMC4869441
Urol Ann. 2016 Apr;8(Suppl 2):S116–S118.

Management of posterior urethral rupture in boys

A. H. Kardar, T. Sundin, S. Ahmed

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Between 1989 and 1995, 15 boys with supra membranous urethral rupture were seen. The patients were 3 years to 17 years of age at the time of injury. Thirteen boys were run over or crushed by a moving vehicle and 2 were thrown out of a car involved in the accident. All patients had a fractured pelvis and the majority also had other major injuries. All children had their initial management at the referring hospital and were received at King Faisal Specialist Hospital with a supra pubic cystectomy. The urethral distraction defect was from 1 cm to 2 cm in 6 patients and up to 4 cm in the rest. Abdomino-perineal transpubic urethroplasty (Turner Warwick) was performed 6 months to 18 months after the injury in 11 patients. After perineal mobilization of the bulbar urethra, supra pubic exploration was undertaken. The distal prostatic urethra was laid open carefully avoiding any dorsal anastomosis with 1-1.5 cm overlap over a fenestrated catheter. A pedicle of omentum was used to fill the peri-anastomotic cavity. In one patient, urethroplasty was done through transperenial approach only. Postoperative Cystourethrogram showed a wide anastomosis in all cases. On follow up (4-44 months) there are no strictures. Thirteen patients are continent and 10 patients have intact erections. Supra membranous urethral rupture is a common injury in Saudi Arabia. Initial management with supra pubic cystostomy at the time of injury would appear to be appropriate. Delayed reconstruction is recommended 6 months after the injury for which purpose abdomino-perennial urethroplasty gives satisfactory results.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital - Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S116–S118.

Urethral and vaginal injury in girls

S. Ahmed, K. Fouda-Neel

Departmrnt of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Three girls with major urethro-vaginal injury following blunt abdominal trauma were referred after initial management elsewhere. In two, there was complete loss of the urethra with a closed bladder base and a vaginal injury. They were managed by construction of a neo-urethra using a flipped anterior bladder wall tube. The third patient with major perineal soft tissue loss, extensive vaginal laceration and rupture of the bladder neck and urethra had a modified Young-Dees-Leadbetter bladder neck reconstruction. The first patient is continent and the second (only 3 years old and short follow up) is showing encouraging signs. The third patient is incontinent and further surgery - possibly a continent diversion - may be necessary.

Pelvic fracture following blunt abdominal trauma in girls may be associated with major urethro-vaginal injury with a potential for serious morbidity. Surgical ingenuity is required to successfully repair such injuries. In those with complete loss of the urethra, a flipped anterior bladder wall tube neo-urethra is suitable.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital - Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S116–S118.

Major injuries to the urinary tract in association with childbirth

V. C. Onoura, R. Al Ariyan, A. H. Koko, N. Al Jawini

Department of Urology, Riyadh Medical Complex, Riyadh, Saudi Arabia

This retrospective study was designed to determine the incidence of major injuries to the urinary tract that occur during parturition and to assess their management. Twenty-one such injuries were managed in the Maternity and Children's Hospital, Riyadh, between 1993 and 1996. The total number of deliveries in the four year period was 48,693, giving an incidence of major urinary injuries of 43 per 100,000 births. There were 4,622 deliveries by Cesarean section, revealing a section rate of 9.5%. Major bladder ruptures occurred in 10 women in association with ruptured uteri. There were 8 unilateral and one bilateral ureteric injuries resulting from Cesarean sections. One ureter was injured during repair of a deep cervical laceration. There was one case of rupture of a diseased kidney during labor. All the bladder injuries were discovered either on the table or soon after delivery. Pelvic congestion, hemorrhage and distortion of anatomical relationships caused by pregnancy made bladder repair especially difficult. Successful repair was achieved in 0 cases employing limited excision of tissues and liberal drainage. One woman developed VVF and small capacity bladder, and required augmentation cystoplasty in addition to repair of fistula. The ureteric injuries were diagnosed in the early puerperium. Exploration and repair was preceded by a period of nephrostomy drainage. This approach was associated with good results in all cases.

Presented at the: 10th Saudi Urology Conference King Fahad National Guard Hospital 26-28 November 1996

Urol Ann. 2016 Apr;8(Suppl 2):S116–S118.

Urethral injury in children

A. H. Kardar, S. Ahmed, E. Lindstedt

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Urethral disruption as a result of pelvic fracture injury is very common in children. Female urethral injuries are considered to be much less common than male. We present our experience of management of 26 such patients.

Patients and Methods: During 1989-1999 twenty-six children were admitted after having initial management at the referring hospital. There were 22 boys and 4 girls, age range 15 months to 18 years (mean 9). Twenty-four patients were involved in road traffic accidents and two fell from height. All these patients had pelvic fracture and the majority had other associated injuries. All 4 girls had reconstruction of urethra from a flipped anterior bladder wall tube. Trnaspublic urethroplasty was performed in 21 boys and perineal urethroplasty in one.

Results:

Boys: Voiding cystourethrography was done 3 weeks after repair. All 22 boys showed wide urethral anastomosis. After a follow up of six to 108 months all patients voided freely. One patient needed revision of anastomosis at 3 months, one more patient developed mild narrowing of the anastomotic site without a need for further intervention. Eighteen were continent, two were totally incontinent and two had stress incontinence.

Girls: At 24-76 months follow up two girls were continent and voiding spontaneously, one needed CIC to empty her bladder incontinence and one needed urinary diversion to continent appendicovesicostomy for incontinence.

Conclusion: Delayed urethroplasty is a satisifactory method for repair of posterior urethral rupture in boys. Reconstruction of neourethra from the anterior bladder wall may be used for repair of urethral injury in girls.

Presented at the: 13th Saudi Urological Conference Riyadh Armed Forces Hospital 14-17 February 2000 (09-12 Dhu Al Qa’dah 1420)

Urol Ann. 2016 Apr;8(Suppl 2):S116–S118.

Pediatric GU trauma

Abdullah Al Jasser

Department of Urology, Security Forces Hospital, Riyadh, Saudi Arabia

Eight years experience of pediatric GU injuries in Riyadh Central Hospital and Security Forces Hospital. Thirty-seven total injuries (of which 24 were combined major injuries): 15 are renal injuries, 3 ureteral, 4 bladder injuries, 8 urethral and 7 scrotal and penile injuries.

Results: There were 37 children involved in trauma; 24 boys and 13 girls/16 of them were below the age of 5 years, 15 between 5-10 years, and only 6 were more than 10 years. The etiology was mainly RTA in 23 cases, fall from a height in 11 cases, and other causes in 3 patients. The main presenting symptoms was abdominal pain in 19 patients; next was hematuria in 17 cases. There were 4 missed major injuries that led to high morbidity and one mortality.

Conclusion: Pediatric genitourinary injuries are not uncommon and they are not different from adult genitourinary injuries. Management should be on an individual basis. Kidney size is relatively big in children, so deceleration injuries should be suspected. S/P catheter is the best immediate management for urethral injuries. Missed injuries can cause high morbidity and mortality.

Presented at the: 11th Saudi Urological Conference King Fahd Military Medical Complex – Dhahran 24-26 February 1998 (27-29 Shawwal 1418)

Urol Ann. 2016 Apr;8(Suppl 2):S116–S118.

One-stage delayed repair of posterior urethral rupture

Joseph N. Corrier

Department of Urology, Medical School, The University of Texas, Houston, Texas, USA

We have performed 63 one-stage delayed repairs of complete posterior urethral ruptures in 60 men with at least one-year follow up. Two were due to gunshot wounds and 58 secondary to a pelvic fracture. Fifty-eight were done by the perineal approach and 5 required an abdominal/perineal approach. Surgical complications were 2 (3%) rectal injuries, 3 (5%) restrictures that required reoperation and 20 (32%) restricutres that required either dilation or visual internal urethrotomy. By one-year post surgery all had a patent urethra and did not require instrumentation. At one-year 43 (72%) voided normally, 5 (8.3%) were areflexic and performed self-catheterization, 5 (8%) had urge incontinence and 5 (8.3%) mild stress incontinence requiring no treatment. Two (2.1%) had moderate stress incontinence that responded to imipramine (1) and collagen injection (1). Patients that were potent preoperatively 31 (52%) remained potent postoperatively. Of the 29 (48%) who were impotent pre and immediately postoperatively, 9 regained potency at one year. However, at one year the quality of erections of the 40 potent men was normal in only 22/60 (37%) and fair to poor in 18/60 (30%). Details of the operative procedure will be discussed.

Presented at the: 13th Saudi Urological Conference Riyadh Armed Forces Hospital 14-17 February 2000 (09-12 Dhu Al Qa’dah 1420)

Urol Ann. 2016 Apr;8(Suppl 2):S116–S118.

The spectrum and management of circumcision induced urethral injuries

S. M. Soliman1,2

1Department of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia, 2Department of Urology, Children's Hospital of Ain Shams University, Cairo, Egypt

Purpose: To report a single operator experience with late presenting circumcision induced urethral injuries in a retrospectively evaluated series from 2 tertiary referral centers.

Patients and Methods: The records of 27 boys (mean age 3.5 years, range 3 months – 15 years) referred over the last 5 years for circumcision related injuries were reviewed. In 52% (14/27) circumcision was performed by health care professionals of which 9 (33%) were after Plastibell utilization, while in 48% (23/27) circumcision was performed by local barbers. Seventeen boys (63%) had a pure urethrocutaneous fistula with an intact glans, 9 were located at the coronal margin and managed by splitting the glans and using a Methieu style skin flap in 2 or a vascularized onlay penile skin flap in 7. Eight patients had glanular fistulae which were repaired by glans splitting and approximation in 3 and urethral mobilization in 5. Four (15%) had partial glans amputation of which 3 were managed by urethral realignment and penile recapping with the remaining of the glans, while one was managed by urethral mobilization. Four (15%) had a concealed glans with meatal stenosis. These were managed by circumferential release, degloving and meatotomy. Two (7%) had near-total penile loss induced by a diathermy injury; both had mobilization of the corpora from pubic bones in attempted penile lengthening.

Results: Eighty-eight percent (15/17) of boys with urethrocutaneous fistula voided with a single stream, 12% (2/17) had recurrence which was repaired with a dorsal onlay skin flap. All other patients with partial glans amputation and those with concealed glans had functionally acceptable results except one from the former group who needed a repeat meatotomy. Unsatisfactory functional and cosmetic outcome was seen in both boys with near-total penile loss. Follow up range was 7 months – 5 years.

Conclusion: Circumcision induced urethral injuries have a wide spectrum of presentation. Acceptable functional results can be obtained with employing various techniques including the contradictory urethral mobilization maneuver. Loss of a significant portion of the phallus remains a challenging problem to address. Contrary to our expectations, healthcare professionals were implicated in >50% of presenting cases which we find alarming and necessitates institution and spreading of safe practice guidelines concerning this commonly performed procedures.

Presented at the: 16th Saudi Urological Conference King Faisal Specialist Hospital and Research Centre 2-4 March 2004 (11-13 Muharram 1425)

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