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Elsingergy MM, Bellah RD, Back SJ, Weiss DA, Darge K. Retrograde urethrography in children: a decade of experience at a children's hospital. Pediatr Radiol 2023; 53:862-874. [PMID: 36797371 PMCID: PMC9935245 DOI: 10.1007/s00247-023-05589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/17/2022] [Accepted: 12/30/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Retrograde urethrography (RUG) is a radiologic procedure that optimizes imaging evaluation of the urethra, particularly in settings of difficulty with micturition or urethral injury. OBJECTIVE To review our experience with RUG at a large pediatric radiology practice. MATERIALS AND METHODS We conducted a retrospective review of medical records and fluoroscopic images of RUGs performed from January 2010 to December 2020. RESULTS We identified 180 RUG exams (median frequency 17 exams per year), all in male children (median age 13 years). The most common indications were stricture (42%; n=76), postsurgical evaluation (34%; n=62) and trauma (16%; n=29). The most commonly used catheter was Foley (40%; n=72), with a median catheter size of 5 French (Fr) for infants younger than 1 year, 7 Fr for children ages 1-5 years and 8 Fr for children older than 5 years. About a third of the children (57; 32%) had combined voiding cystourethrography (VCUG)-RUG exams. Water-soluble contrast agent, either 17% or 43% Cysto-Conray, was used. Most RUG exams were normal (46%; n=83). The most common urethral pathology was stricture (30%; n=54), commonly involving a bulbar urethra (n=26). Urethral trauma was seen in 11 children (6%), 10 bulbar and 1 membranous. Most children with stricture were surgically treated (n=40; 74%), whereas most children with trauma were conservatively treated (n=8; 73%). The remaining diagnoses included diverticula, polyps, valves, fistulas and duplications, constituting <17% of our sample; most of these were surgically treated. Four exams (2%) were non-diagnostic. RUG showed 89% sensitivity and 97% specificity compared to cystourethroscopy/VCUG findings. Technical difficulties occurred in 14 (8%) children (e.g., pain or inappropriate catheter seal). CONCLUSION Our experience indicates that when catheterization techniques are properly tailored, RUG provides a useful and successful radiologic method of evaluating the pediatric male urethra.
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Affiliation(s)
- Mohamed M. Elsingergy
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Richard D. Bellah
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA ,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Susan J. Back
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA ,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Dana A. Weiss
- Department of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Kassa Darge
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA ,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
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Yatindra IBGTY, Santosa KB, Yatindra IBT. Vaginal calculus in adult woman: A case report. Urol Case Rep 2022; 42:102013. [PMID: 35530552 PMCID: PMC9073206 DOI: 10.1016/j.eucr.2022.102013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 11/05/2022] Open
Abstract
Vaginal calculus in adult woman is an extremely rare condition. The diagnosis and management can be challenging due to rare cases. We present a case of vaginal calculus in adult woman secondary to urethrovaginal fistula due to previous pelvic trauma. The patient barely has no complaint until one day she is experiencing infertility. Stone extraction, vaginoplasty and urethroplasty with Martius flap were performed with satisfactory results.
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Radhakrishna V, Vepakomma D, Manjunath D. The management of perineal trauma in children. J Indian Assoc Pediatr Surg 2022; 27:65-70. [PMID: 35261516 PMCID: PMC8853604 DOI: 10.4103/jiaps.jiaps_322_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/11/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Abstract
Aims: This study aimed to evaluate the outcome of perineal trauma in children and to a define protocol for their management. Methods: It is a retrospective study of children who presented with perineal injury between August 2012 and December 2020. The patients were classified into three groups: Group-1 included children with perineal and genitourinary injuries; Group-2 included patients with perineal and anorectal injuries; and Group-3 included patients with perineal, genitourinary, and anorectal injuries. All patients underwent primary repair. Those with full-thickness anorectal injury underwent an additional covering colostomy, while urethral disruption was initially managed by a diverting suprapubic cystostomy (SPC). Results: A total of 41 patients were studied. Impalement injury (n = 11; 27%) and sexual abuse (n = 11; 27%) were the most common mechanisms of injury. Twenty (49%) patients had anorectal injuries with 10 (24%) each of partial-thickness and full-thickness injury. There were 24 (59%) genital injuries and five (12%) urethral injuries. One patient each developed anal and vaginal stenosis, both were managed with dilatation. One patient developed a rectovaginal fistula repaired surgically at a later date. Conclusion: Perineal injuries with resultant anorectal or genital damage require a careful primary survey. Following stabilization, an examination under anesthesia as a set protocol will help determine the treatment strategy. A colostomy is essential in the acute management of severe anorectal injuries to reduce local complications and preserve continence. Urethral injuries may warrant an initial diverting SPC in selected cases.
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Alaoui O, Khattala K, Bouabdallah Y. Tuméfaction pénoscrotale post-traumatique révélant une rupture de l’urètre antérieur. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chukwubuike KE, Enebe JT, Nduagubam OC. Urethral injury in children: Experience in a teaching hospital in Enugu, Nigeria. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820927423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Urethral injury in children is uncommon, and its treatment is challenging. This study evaluated our experience in the management of urethral injuries in children who presented at the paediatric surgical unit of a teaching hospital in Enugu, Nigeria. Methods: The medical records of patients younger than 15 years old admitted to our centre with urethral injury from January 2008 and December 2017 were reviewed retrospectively. Results: During the period of the study, 11 cases (all male) were managed. The mean age of the patients at presentation was 11 years. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the most injured part of the urethra. All the patients had urethroplasty through the perineal approach. There was 90% success at first instance. One patient required redo urethroplasty. Conclusion: Urethral trauma is associated with considerable morbidity. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the part of the urethra most affected. Transperineal urethroplasty was an effective modality of treatment.
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Affiliation(s)
| | - Joseph Tochukwu Enebe
- Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Nigeria
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Baradaran N, McAninch JW, Copp HL, Quanstrom K, Breyer BN, Hampson LA. Long-term follow-up of urethral reconstruction for blunt urethral injury at a young age: urinary and sexual quality of life outcomes. J Pediatr Urol 2019; 15:224.e1-224.e6. [PMID: 30967356 PMCID: PMC6588442 DOI: 10.1016/j.jpurol.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/22/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Little is known about long-term patient-reported outcomes following surgical repair for pediatric blunt urethral trauma. OBJECTIVE The purpose was to evaluate long-term urinary outcomes, sexual function, and quality of life (QOL) of patients who undergo urethroplasty for blunt urethral trauma in childhood. STUDY DESIGN After IRB approval, we retrospectively reviewed the records of patients who sustained blunt urethral injury at ≤18 years and underwent urethroplasty at our institution between 1978 and 2013. We then used a web-based survey to assess urinary/sexual/ejaculatory function and overall QOL using validated questionnaires. RESULTS Of 68 eligible patients, 15 were able to be contacted (table). Median age of injury, age at urethroplasty, and age at follow-up were 17 (4-18), 17 (5-20), and 19 (13.5-21.5) years, respectively. The stricture was membranoprostatic in eight and bulbar in seven patients, with median length of 2 (1.6-2.6) cm. Excision/primary anastomosis was performed in all but three patients who required a buccal graft. Overall, 80% were 'very satisfied' and 20% were 'satisfied' with surgery. One patient reported a subsequent urethral intervention. On urethral stricture surgery patient-reported outcome measurement, the median bother (0 least, 24 worst) was 10 (8-12.5). The force of urine stream (1 strongest, 4 weakest) was 2 (1.5-2), with no report of urinary incontinence. The median Sexual Health Inventory for Men score (0 worst, 25 perfect) was 24 (22.5-24). The median ejaculatory function score (0 worst, 15 normal) was 14 (13-14.75). Six patients had fathered children and none reported infertility. Three patients reported <30° penile curvature not interfering with sex. Median QOL (0 worse, 10 best) was 8 (7.5-8). CONCLUSIONS Urethroplasty after blunt urethral injury in young adult population is associated with a high long-term success rate with a low rate of long-term urinary and sexual consequences in adulthood.
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Patel DN, Fok CS, Webster GD, Anger JT. Female urethral injuries associated with pelvic fracture: a systematic review of the literature. BJU Int 2017; 120:766-773. [PMID: 28805298 DOI: 10.1111/bju.13989] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To review systematically the literature on female urethral injuries associated with pelvic fracture and to determine the optimum management of this rare injury. Using Meta-analysis of Observational Studies in Epidemiology criteria, we searched the Cochrane, Pubmed and OVID databases for all articles available before 30 June 2016 using the terms 'female pelvic fracture urethroplasty', 'female urethral distraction', 'female pelvic fracture urethral injury' and 'female pelvic fracture urethra girls.' Two authors of this paper independently reviewed the titles, abstracts, and articles in duplicate. We identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review, including 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair; 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar after both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis after delayed repair. Patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair. The optimum management of female urethral distraction defects is based on very-low-quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is haemodynamically stable appears to be optimal.
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Affiliation(s)
- Devin N Patel
- Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Cynthia S Fok
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - George D Webster
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA
| | - Jennifer T Anger
- Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Primary endoscopic realignment in female urethral injuries with pelvic fracture can reduce avoidable morbidity. Indian J Surg 2014; 75:31-3. [PMID: 24426380 DOI: 10.1007/s12262-012-0424-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 03/02/2012] [Indexed: 10/28/2022] Open
Abstract
Female urethral injuries associated with Pelvic fracture are not as uncommon as it was previously thought. Primary endoscopic realignment of proximal urethra and catheterisation on guide-wire is very good procedure in early presentation. Every female patient with urethral injury due to pelvic fracture should be referred for primary repair to decrease the avoidable morbidity of these patients.
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Voelzke BB, Breyer BN, McAninch JW. Blunt pediatric anterior and posterior urethral trauma: 32-year experience and outcomes. J Pediatr Urol 2012; 8:258-63. [PMID: 21664873 PMCID: PMC3565598 DOI: 10.1016/j.jpurol.2011.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To analyze our experience with delayed repair of pediatric urethral trauma. MATERIALS AND METHODS From 1978 to 2007, 26 boys <18 years old (mean age 15.0) presented for delayed repair of urethral stricture after blunt trauma. Anterior and posterior urethral injuries were separately stratified. RESULTS There were 8 anterior and 18 posterior urethral strictures. All patients presented in a delayed fashion. Mean follow up of the anterior cohort was 2.9 years. All repairs were performed via a ventral onlay buccal graft or anastomotic approach. The mean follow up of the posterior cohort was 1.1 years, and all posterior urethral injuries were repaired via an anastomotic approach. Overall success for anterior stricture disease was 88.9% and for posterior stricture disease was 89.5%. All three urethroplasty failures responded favorably to internal urethrotomy; however, one failed anterior repair and one of the two failed posterior repairs required two internal urethrotomy operations for success. No secondary urethroplasty operations were required and ultimately all patients were voiding per urethra without need for urethral dilation. CONCLUSION Delayed, definitive repair of pediatric urethral trauma via open urethroplasty has a high success rate.
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Affiliation(s)
- Bryan B Voelzke
- San Francisco General Hospital, San Francisco, CA 94110, USA.
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Pichler R, Fritsch H, Skradski V, Horninger W, Schlenck B, Rehder P, Oswald J. Diagnosis and Management of Pediatric Urethral Injuries. Urol Int 2012; 89:136-42. [DOI: 10.1159/000336291] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Straddle injuries are common in children. At the end of this case presentation, you should be able to describe the approach to the evaluation and treatment of a straddle injury, list indications for gynecologic consultation and/or sedation, plan disposition, and discuss pitfalls to avoid in evaluating patients with straddle injuries.
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Eyk NV, Allen L, Giesbrecht E, Jamieson MA, Kives S, Morris M, Ornstein M, Fleming N. Pediatric vulvovaginal disorders: a diagnostic approach and review of the literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 31:850-862. [PMID: 19941710 DOI: 10.1016/s1701-2163(16)34304-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Vulvovaginal complaints in the prepubertal child are a common reason for referral to the health care provider. The Cochrane Library and Medline databases were searched for articles published in English from 1980 to December 2004 relating to vulvovaginal conditions in girls. The following search terms were used: vulvovaginitis, prepubertal, pediatric, lichen sclerosis, labial fusion, labial adhesion, genital ulcers, urethral prolapse, psoriasis, and straddle injuries. The objectives of this article are to review the normal vulvovaginal anatomy, describe how to perform an age-appropriate examination, and discuss common vulvovaginal disorders and their management in young girls.
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Affiliation(s)
- Nancy Van Eyk
- Department of Obstetrics and Gynaecology, IWK Health Centre, Dalhousie University, Halifax NS
| | - Lisa Allen
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Ellen Giesbrecht
- Department of Obstetrics and Gynaecology, BC Women's Hospital, University of BC, Vancouver BC
| | - Mary Anne Jamieson
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston ON
| | - Sari Kives
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Margaret Morris
- Department of Obstetrics and Gynecology, Health Sciences Centre, University of Manitoba, Winnipeg MB
| | - Melanie Ornstein
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Nathalie Fleming
- Division of Pediatric and Adolescent Gynecology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa ON
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Experiencia en reconstrucción postraumática de uretra posterior en niños. Hospital Universitario San Vicente de Paúl. Medellín 1987-2007. Actas Urol Esp 2009. [DOI: 10.1016/s0210-4806(09)74168-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Liu B, Huang X, Lu J, Zhang Z, Wang P, Huang Z. Vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl. UROLOGICAL RESEARCH 2008; 36:73-5. [PMID: 18172633 DOI: 10.1007/s00240-007-0129-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 12/07/2007] [Indexed: 10/22/2022]
Abstract
The author reports a case of vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl. The initial urethrovaginal fistula and vaginal stenosis resulted from pelvic trauma after a traffic accident, with subsequent surgical urethral realignment and anterior colporrhaphy without success. The patient had continuous urinary incontinence for a duration of 11 years after surgery, and was finally diagnosed with urethrovaginal fistula with primary multiple vaginal calculi in our hospital. Surgeries were performed to remove the stones and repair the urethrovaginal fistula. Colpoplasty was also given by an obstetrician-gynecologist to solve the vaginal stenosis. After the procedure, the girl urinated normally. At her 3-month follow-up, the patient had no sign of urine leakage.
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Affiliation(s)
- Ben Liu
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 QingChun Road, 310003 Hangzhou City, Zhejiang Province, People's Republic of China.
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Abstract
Injuries to anterior urethra are uncommon, mainly due to blunt trauma, and rarely associated with pelvic fractures or life threatening multiple lesions. Straddle type injury is the most frequent lesion, in which the immobile bulbar urethra is crushed or compressed on the inferior surface to the pubic symphysis. Diagnosis of urethral injury is easy, suspected due to trauma circumstances, presence of urethrorragy or initial hematuria, and eventually difficult micturition and penile scrotal for perineoscrotal hematoma. It should always be confirmed and classified by retrograde urethro-gram, realized either immediately or after a few days. Initial acute management is suprapubic cystostomy, if possible before any attempt of urethral catheterization or miction. Urethral contusions only require this urinary diversion or urethral catheter for a few days and usually heal without any sequelae. Management of partial and complete disruptions remains controversial: suprapubic diversion only and secondary endoscopic or open surgical repair of the urethral stricture that occurs in the great majority of the cases (always after complete disruption), early endoscopic realignment and prolonged urethral catheterization (4 for 8 weeks according to the lesion), in partial disruptions, more controversial in complete disruptions; delayed (after a few days) open surgical repair (urethrorraphy) that is the preferred European and French attitude for complete disruptions. Penetrating anterior urethral trauma and urethral lesions associated with penile fracture require immediate surgical exploration and repair if possible. After anterior urethral disruption, the main morbidity is urethral stricture very often requiring surgical treatment (visual urethrotomy if the structure is short, end to end spatulated urethrorraphy, flap or graft urethroplasty if longer).
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Affiliation(s)
- J Biserte
- Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel-Polonovski, 59037 Lille, France.
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Abstract
BACKGROUND Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC). METHODS A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred. RESULTS A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks-15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1-75) and there were three deaths. Forty-two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury. CONCLUSIONS The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long-term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC.
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Affiliation(s)
- Andrew J A Holland
- Department of Paediatric Surgery, Royal North Shore Hospital, The University of Sydney, St Leonards, New South Wales, Australia.
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Nieuwenhuijs JL, De Jong TPVM. Two cases of unusual urethral complications after resection of sacrococcygeal teratoma. J Pediatr Surg 2003; 38:E14-5. [PMID: 14614737 DOI: 10.1016/j.jpedsurg.2003.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This report describes 2 rare complications of a sacrococcygeal teratoma leading to urethral obstruction in 1 case and midurethral necrosis in the other. The anomalies appear to be based on pressure necrosis of the urethra by mechanical compression between the symphysis pubis and the teratoma.
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Affiliation(s)
- Jaap L Nieuwenhuijs
- Pediatric Renal Center, Wilhelmina Children's Hospital, UMC, Utrecht, The Netherlands
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Abstract
PURPOSE OF REVIEW Abdominal and pelvic injuries are often associated with devastating lower urinary tract injuries. The literature is replete with studies involving male lower urinary tract trauma, however the diagnosis and management of similar injuries in women is not as well covered. In this article we will review recent advances in the diagnosis and management of female lower urinary tract trauma. RECENT FINDINGS The recent literature emphasizes the importance of diagnosing and managing female lower urinary tract injuries, both of the bladder and the urethra, caused by blunt or penetrating trauma to the lower abdomen, pelvis and perineum. Successful management of these injuries is based upon accurate diagnosis, recognition of associated injuries, and prompt treatment. Diagnosis and treatment of female bladder perforation have been well established. Reports of female urethral injuries are scarce, however, and subsequently the management is not standardized. SUMMARY High suspicion, accurate diagnosis and prompt treatment are key for the successful management of female lower urinary tract injuries associated with lower abdominal, pelvic and perineal trauma. A standardized algorithm for management of female urethral injuries would be helpful.
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Abstract
BACKGROUND Traumatic urethral disruptions in children differ anatomically from those of adults. In children, the posterior urethra is not protected by the prostate and may be injured at any level. The management of traumatic rupture of the urethra still a matter of debate, and there is no agreement as to which is the best of 3 options. METHODS This was a retrospective analysis. Over a 12-year period the authors dealt with 21 urethral disruptions. The authors had detailed follow-up of 20 patients (14 posterior and 6 anterior). Trans-symphyseal urethroplasty (6 early primary repairs and 3 delayed repairs) for complete posterior urethral disruptions was performed. The early repairs were carried out within 7 days of the injury. Primary alignment was performed for 3 of the 4 partial ruptures of the posterior urethra and for all 6 anterior urethral disruptions. Postoperatively, the patients were evaluated for incontinence, penile erectile dysfunction, and stricture formation. RESULTS In one of the early repairs a stricture developed that responded to dilatations. A second patient with bladder neck injury had incontinence after the repair. She underwent a urethral lengthening procedure and still has stress incontinence. Erections were observed in all 4 boys. One of the delayed repairs developed a stricture postoperatively. Of the 9 partial ruptures (6 anterior and 3 posterior) that underwent primary alignment, 4 had strictures. Some of these strictures required up to 5 dilatations or internal urethrotomy for cure. One patient with complete rupture underwent primary alignment, which broke down, and a long stricture developed. This patient is still awaiting a delayed repair. One posterior partial rupture, repaired primarily at another hospital, had a stricture and an urethrocutaneous fistula that responded to curettage and dilatations. CONCLUSIONS Primary repairs required less hospitalization and a shorter duration of indwelling catheters. In light of this experience the authors recommend a primary repair in patients with complete posterior urethral disruptions.
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Affiliation(s)
- Manasvi Upadhyaya
- Department of Paediatric Surgery, Royal Hospital, Muscat, Sultanate of Oman
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