S Ahmed1, K F Neel. 1. Department of Surgery (MBC-40), King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
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.
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.