Injury to the posterior urethra: management in children

Abstract

Our experience with the management of ten children with posterior urethral rupture in the early phase is presented. In seven children (six boys and one girl) in whom a complete rupture had occurred, a suprapubic approach was used and a Foley catheter was passed as a splint after end-to-end primary anastomisis of the torn urethra. In three cases rupture was partial; one was iatrogenic and the others were traumatic. The former was managed by a perineal incision with urethral reconstruction and a cystostomy for urinary diversion. In one traumatic partial tear, simple catheterization through the external meatus was sufficient for perfect healing, while in the second after unsuccessful catheterization, a cystostomy for 2 weeks led to a satisfactory outcome. Three of the seven children with complete rupture developed strictures, which required one or more sounds; one of them also underwent two internal (visual) urethrotomies. All currently have stable stricture formation. One other boy with strictures, who is now 16 years of age, periodically needs bougienage and is completely impotent with probably diminished libido. Nine children now have normal micturition and in six boys erections have been established. Two have begun to ejaculate, but the rest are still too young for definite conclusions. We believe that for a completely disrupted urethra primary end-to-end anastomosis with a few approximating sutures over a Foley catheter placed as a splint is feasible in children and should be attempted as the procedure of choice.