Pelvic fracture-associated urethral injuries in girls: experience with primary repair.
OBJECTIVE
To present our experience with four urethral injuries in females accompanying a pelvic fracture, managed with primary repair or realignment of the urethra.


METHODS
There were three teenage girls and one adult (22 years old). All the patients had complete urethral injuries associated with a pelvic fracture from accidents. They were managed by immediate suprapubic cystostomy followed by repair or realignment of the urethra over a catheter on the same day. The catheter was removed after 3 weeks and a voiding cysto-urethrogram taken. Thereafter they were followed with regular urethral calibration.


RESULTS
All patients voided satisfactorily with a good stream; three were fully continent and the fourth had transient stress urinary incontinence. One patient needed dilatation at 2 months and another visual internal urethrotomy at 5 months. At a mean (range) follow-up of 33 (9-60) months all the patients had a normal voiding pattern and were continent; none developed vaginal stenosis.


CONCLUSIONS
Primary repair of the urethra, and if that is impossible, simple urethral realignment over a catheter, is the procedure of choice for managing female urethral injury associated with a pelvic fracture. The procedure has the additional advantage of reducing the risk of vaginal stenosis.
Dorairajan
Lalgudi N
LN
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. gowidorai@sify.com
Gupta
Harendra
H
Kumar
Santosh
S
D000293:Adolescent; D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D010384:Pelvic Bones / Q000293:injuries*; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D014621:Vagina / Q000293:injuries