Pelvic Fracture Urethral Distraction Defects in Preschool Boys: How to Recognize and Manage?

Lin Wang; Jiasheng Chen; Rong Lv; Jijian Wang; Gong Chen; Chongrui Jin; Chao Feng; Yinglong Sa

doi:10.1016/j.urology.2021.10.026

Pelvic Fracture Urethral Distraction Defects in Preschool Boys: How to Recognize and Manage?

Urology. 2022 Jan:159:191-195. doi: 10.1016/j.urology.2021.10.026. Epub 2021 Nov 12.

Authors

Lin Wang¹, Jiasheng Chen¹, Rong Lv¹, Jijian Wang¹, Gong Chen¹, Chongrui Jin¹, Chao Feng¹, Yinglong Sa²

Affiliations

¹ Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China.
² Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China. Electronic address: sayinglong331@sina.com.

PMID: 34774932
DOI: 10.1016/j.urology.2021.10.026

Abstract

Objective: To share the cases of pelvic fracture urethral distraction defect (PFUDD) in preschool boys and evaluate the transperineal anastomotic urethroplasty strategy for the treatment of these cases.

Materials and methods: Between January 2010 and May 2021, 8 preschool boys (<6 years) with PFUDD underwent the transperineal anastomotic urethroplasty in our center were retrospectively reviewed. Etiology was traumatic pelvic fracture in all boys. The type of trauma included: fall injury in 1 and vehicle crush injury in 7. Urethroplasty was performed at least 3 months after initial trauma or the last failed intervention. One of them suffered from PFUDD associated with urethrorectal fistula received urethroplasty combined with fistula repair. A successful urethroplasty was defined as restoring the patency and continuity of urethra and no further interventions were needed.

Results: Follow-up was obtained in all the 8 preschool boys for 3-135 (median: 65) months. The average age was 4.1 years old (range 1-5). After operation, the final success rate was 100%. Neither stenosis recurrence nor urinary fistulas were reported during follow-up. Of the 8 boys, 1 developed urinary incontinence, only occurring after high-intensity exercise such as running. Potency state could not be evaluated for all boys due to the young age. One boy reported having normal morning erection after a follow-up of 135 months.

Conclusion: PFUDD in preschool boys is a challenge for both the urologist and parent. Our study preliminarily confirmed that the progressive anastomotic urethroplasty strategy can ensure a high success rate.

MeSH terms

Anastomosis, Surgical / methods
Child, Preschool
Fractures, Bone* / diagnosis
Fractures, Bone* / etiology
Fractures, Bone* / surgery
Humans
Male
Pelvic Bones / injuries*
Plastic Surgery Procedures / adverse effects
Plastic Surgery Procedures / methods
Postoperative Complications* / diagnosis
Treatment Outcome
Urethra* / diagnostic imaging
Urethra* / injuries
Urethra* / surgery
Urinary Incontinence* / diagnosis
Urinary Incontinence* / etiology
Urologic Surgical Procedures, Male* / adverse effects
Urologic Surgical Procedures, Male* / methods
Wounds and Injuries / complications