Long-term urologic, orthopedic, and psychological outcome of posterior urethral rupture in children

Abstract

Objectives To evaluate the long-term urologic, orthopedic, and psychological outcome of children after posterior urethral rupture (PUR) due to pelvic trauma. Methods We retrospectively reviewed the records of 49 children with PUR from 1986 to 2000. The long-term urologic results were determined by voiding function, continence, and erectile function. The orthopedic results were determined by pelvic radiography and a questionnaire. Psychiatric diagnoses were made using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria and the Structured Clinical Interview for DSM-IV Axis I Disorders. Results The mean follow-up was 12 years (range 4 to 17). The average age was 8 years at the time of the trauma and 20 years at the last follow-up. Urethral continuity was achieved in 97.9% of the children. Of the 49 patients, 19 had at least one urologic complication, 18 had orthopedic pathologic findings, and 21 had psychiatric diagnoses. The number of urologic procedures required (more than three), presence of long-term complications, and total number of hospitalizations (more than three) secondary to the injury significantly affected the development of a psychological disorder. Conclusions The results of our study have shown that posttraumatic PUR in children is associated with a significant rate of long-term complications. Nonoperative treatment of pediatric pelvic fractures associated with PUR has been quite successful. Repeated operations, the presence of long-term urologic complications, and frequent and long hospital stays result in serious attendant psychological problems. Therefore, careful and prolonged follow-up of posttraumatic urethral injury with a multidisciplinary approach is necessary to provide better outcomes and a better quality of physical and social life for these children.