title: Diagnosis and management of pediatric urethral injuries.
abstract: OBJECTIVE
  The incidence of urethral injuries in children is rare due to the fact that the urethra is short, mobile and protected by the pubic bone. The management of urethral trauma in childhood remains controversial because of the limited expertise of most urologists.
  
  
  METHODS
  We performed a literature review by searching the Medline database for articles published between 1975 and 2010 based on clinical relevance. Electronic searches were limited to the keywords 'pediatric', 'urethral injury', 'trauma' and 'reconstruction'.
  
  
  RESULTS
  Retrograde urethrography is considered the gold standard for diagnosis of urethral injuries. The initial management should ensure drainage of the bladder either by suprapubic cystostomy or urethral realignment if possible: in complete anterior urethral disruption as well as in children with life-threatening pelvic and intra-abdominal injuries after posterior urethral injuries, a deferred repair after 3 months is necessary. Immediate primary suturing of disrupted and dislocated urethral ends should be avoided because of high complication rates. Primary repair, however, of the defect is possible in girls avoiding a 2-stage approach.
  
  
  CONCLUSIONS
  The aim of therapy is minimizing remote damages such as urethrocutaneous fistulae, periurethral diverticulae, strictures, incontinence and impotence with different therapeutic management depending on classification of the injury and the presence of life-threatening injuries.
authors.affiliation: Department of Urology and Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria. renate.pichler @ i-med.ac.at
authors.forename: Renate
authors.initials: R
authors.lastname: Pichler
authors.forename: Helga
authors.initials: H
authors.lastname: Fritsch
authors.forename: Viktor
authors.initials: V
authors.lastname: Skradski
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Barbara
authors.initials: B
authors.lastname: Schlenck
authors.forename: Peter
authors.initials: P
authors.lastname: Rehder
authors.forename: Josef
authors.initials: J
authors.lastname: Oswald
mesh_terms: D002404:Catheterization; D002648:Child; D003558:Cystoscopy / Q000379:methods; D003559:Cystostomy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010384:Pelvic Bones / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography / Q000379:methods; D014521:Urethra / Q000293:injuries*; D014522:Urethral Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D001743:Urinary Bladder / Q000473:pathology; D013520:Urologic Surgical Procedures