The management of old urethral injury in young girls: analysis of 44 cases.
OBJECTIVE
Traumatic urethral injury in girls is rare, and there is no consensus on its management. The authors report their 22-year experience.


METHODS
Forty girls presented with urethrovaginal fistula. Twenty-six girls presented with cystostomy tube in place, whereas 17 girls presented with complete urinary incontinence. Incision and dilatation of the obliterated urethra was carried out in 7 patients. Vaginal repair of urethrovaginal fistula was performed in 4 patients. Transpubic reconstruction of the urethra using a modified Young-Dees-Leadbetter procedure with simultaneous repair of the urethrovaginal fistula was performed in 35 patients (once in 27, twice in 5, and 3 times in 3 patients).


RESULTS
Follow-up in 40 girls averaged 3.5 years. Twenty-nine patients have regained normal urinary control, and 11 patients have mild stress urinary incontinence. Four patients were lost to follow-up.


CONCLUSIONS
Simple dilation of the obliterated urethra can reestablish satisfactory urethral patency if the obliterated segment is short. The vaginal approach to urethrovaginal fistula may be successful in patients without concomitant urethral stricture or in those with stricture amenable to simple dilation. The transpubic approach remains the method of choice for repairing complete urethral disruption and severe urethral stricture, especially when associated with urethrovaginal fistula.
Huang
Cheng-ru
CR
Division of Urology, Department of Surgery, Beijing Children's Hospital, Beijing, China.
Sun
Ning
N
Wei-ping
Xie
Hui-wen
HW
Hwang
Andrew H
AH
Hardy
Brian E
BE
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy; D004106:Dilatation; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D007223:Infant; D014521:Urethra / Q000293:injuries*; D014522:Urethral Diseases / Q000209:etiology* / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000628:therapy; D014549:Urinary Incontinence / Q000209:etiology; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery