title: Pelvic fracture urethral distraction defects in children managed by anterior sagittal trans anorectal approach: a facilitating and safe access.
abstract: OBJECTIVE
  Trauma injuries of the posterior urethra resulting from pelvic fracture in children tend to be complete ruptures, with upper dislocation of the prostate. This paper aims to show our experience in using an anterior sagittal transanorectal approach (ASTRA) in the treatment of such injuries.
  
  
  METHODS
  The medical records of 11 patients with pelvic fracture urethral distraction defects who had undergone anastomotic urethroplasty through ASTRA between 1997 and 2009 were reviewed. Ages ranged from 1 year and 6 months to 23 years (mean age 11 years). Of the 11 patients, 8 had previously undergone failed urethroplasties.
  
  
  RESULTS
  In 10 patients it was possible to perform tension free urethroplasty. One patient required inferior pubectomy and separation of the corpora cavernosa. Patients' follow-up time varied from 10 months to 10 years and 9 months (mean 41 months). One patient had a urethral fistula and evolved with a urethral diverticulum successfully managed by diverticulectomy. One patient presented a urethral stenosis managed by urethral dilatation. Of the 11 patients, 9 presented functional urethral flow and are continent. Two patients had no urethral flow. One is undergoing bladder catheterization through the Mitrofanoff principle and the other one through the urethra. No patient presented fecal incontinence or rectourethral fistula.
  
  
  CONCLUSIONS
  This access, which is increasingly being used to approach posterior urethral diseases, has proved to be safe and effective in the treatment of pelvic fracture urethral distraction defects.
authors.affiliation: Hospital Infantil Darcy Vargas, Pediatric Urology Division, Seraphico de Assis Carvalho, 34, São Paulo CEP 05614-040, Brazil.
authors.forename: Luciano Silveira
authors.initials: LS
authors.lastname: Onofre
authors.forename: Jovelino Quintino de Souza
authors.initials: JQ
authors.lastname: Leão
authors.forename: Adriano Luis
authors.initials: AL
authors.lastname: Gomes
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Heinisch
authors.forename: Fernanda Ghilardi
authors.initials: FG
authors.lastname: Leão
authors.forename: José
authors.initials: J
authors.lastname: Carnevale
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D007223:Infant; D010384:Pelvic Bones / Q000293:injuries*; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult