We have located links that may give you full text access.
Use of the perineal and perineal-abdominal (transpubic) approach for delayed management of pelvic fracture urethral obliterative strictures in children: long-term outcome.
Journal of Urology 1998 July
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.
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.
Full text links
Related Resources
Trending Papers
Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024 April 12
Proximal versus distal diuretics in congestive heart failure.Nephrology, Dialysis, Transplantation 2024 Februrary 30
World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management.American Journal of Hematology 2024 March 30
Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.Mental Health Clinician 2023 October
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app