Early primary endoscopic realignment in children with posterior urethral and bladder neck injury

Abstract

The management of bladder neck and posterior urethral injuries is controversial and debate continues in regarding the advisability of immediate versus delayed management. The aim of present study is to present our experience of immediate endoscopic realignment of posterior urethral and bladder neck injuries in children. From June 2016 to July 2019, immediate primary endoscopic realignment was done in children with bladder neck and posterior urethral injuries. Injuries were classified according to Goldman classification of urethral injury. After stabilization, retrograde cystourethrography was performed and endoscopic realignment was done within first 10 h of presentation. Per urethral catheter was left in for 4 weeks. Peri-catheter retrograde urethrocystogram and micturating cystourethrography (MCU) was done 4 weeks after primary realignment. Two patients with type-II injury are continent and have good urinary stream. One patient with type-III injury had stricture at the injury site. Dilatation was done once and child is voiding with good urinary stream. All the three patients with type-IVa injury healed well without any complication and are voiding with good urine flow. One patient with type IV injury is continent and is voiding with good urine flow. Early primary realignment in children with posterior urethral injury and bladder neck injury is safe and effective.