Posterior urethral injuries in children

Objective To review the results of the operative treatment of posterior urethral injuries in children. Patients and methods A total of 29 children (25 boys and two girls, age range 3-14 years) with injuries to the posterior urethra were admitted to this department over 14 years. Twenty-three patients presented immediately after trauma and six were referred after unsuccessful attempt(s) at surgical repair. Results Fourteen patients underwent suprapubic diversion and primary realignment over a catheter. Urethral continuity with normal urinary continence was achieved in seven of these patients. Four patients underwent a re-operation; urethral reconstruction was successful in these patients, but one patient remained incontinent. Primary realignment with anastomosis was performed in nine patients; the results were satisfactory in six. Urethral stricture developed in all of four patients who were managed with a suprapubic cystostomy alone; a staged repair using the transpubic approach was carried out in two of them and one improved. Partial urethral tears in two patients healed with urethral catheterization alone. Conclusion Primary realignment of the urethra with anastomosis and suprapubic diversion resulted in the highest rate of success for normal urethral continuity. Urethral strictures or urinary incontinence were not major problems in this group. Therefore, we recommend this approach for the initial management of urethral injuries in childhood. Transpubic urethroplasties may be reserved for secondary repair.