Use of the perineal and perineal-abdominal (transpubic) approach for delayed management of pelvic fracture urethral obliterative strictures in children: long-term outcome.
J Urol
; 160(1): 160-4, 1998 Jul.
Article
em En
| MEDLINE
| ID: mdl-9628640
PURPOSE: The results of 2 surgical approaches to restore urethral continuity in children with pelvic fracture urethral obliterative strictures were retrospectively reviewed. MATERIALS AND METHODS: From 1980 to 1995, 30 boys 3.8 to 15.4 years old (median age 8.4) with urethral distraction injuries associated with pelvic fracture were treated with delayed 1-stage anastomotic repair. Surgical access was perineal in 15 cases and perineal-abdominal (transpubic) in 15. There were also associated injuries in 13 patients, including bladder neck laceration in 3. Overall postoperative followup ranged from 2 to 17 years (median 8.5). RESULTS: The stricture-free rate of 1-stage anastomotic repair with perineal and perineal-transpubic access was 84 and 100%, respectively. Four recurrent strictures were treated successfully with additional perineal-transpubic anastomotic urethroplasty in 3 patients and internal urethrotomy in 1. Urinary incontinence developed in 1 boy in the perineal group and in 3 in the transpubic group. Retrospectively associated bladder neck injury was related to the original trauma in 3 of the 4 incontinent boys. The remaining child had overflow incontinence due to an acontractile detrusor. On review 3 of the 4 incontinent patients had severe, unstable type IV pelvic fractures. CONCLUSIONS: Children with urethral distraction injuries associated with pelvic fracture require perineal-transpubic exposure when urethral obliterations of 3 cm. or greater develop or local complications are present in the affected area, making it impossible to create a tension-free, spatulated epithelium-to-epithelium anastomosis to restore urethral continuity via the perineal route. This study also supports previous reports that suggest a relationship of urinary incontinence and associated bladder neck injury with severe pelvic fracture rather than with delayed urethral repair.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ossos Pélvicos
/
Estreitamento Uretral
/
Fraturas Ósseas
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Child
/
Child, preschool
/
Humans
/
Male
Idioma:
En
Revista:
J Urol
Ano de publicação:
1998
Tipo de documento:
Article
País de afiliação:
Argentina
País de publicação:
Estados Unidos