Abstract
BackgroundGirls’ pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap.MethodsWe retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients’ trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior urethroplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children.ResultsOperation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period.ConclusionsOur method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.
Highlights
Girls’ pelvic fracture bladder neck avulsion and urethral rupture is rare it causes great morbidity
We introduced 5 cases of girls with intensive bladder neck avulsion and urethral rupture associated with pelvic fracture and elaborated our surgical technique of bladder flap bladder neck reconstruction
Clinical materials From July 2017 to October 2019, 5 girls with bladder neck avulsion and urethral rupture caused by traumatic pelvic fracture were admitted to our institution and accepted surgery
Summary
Girls’ pelvic fracture bladder neck avulsion and urethral rupture is rare it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap. Female urethra with an average length of 4 cm is much shorter and less fixed in the pelvic, the chance of getting injured is low. Pelvic fracture urethral and bladder injuries in girls are rare, the management is complex.
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