Immediate or delayed repair of pelvic fracture urethral disruption defects in young boys: twenty years of comparative experience.

BACKGROUND

The treatment of the patient with pelvic fracture urethral disruption defects (PFUDD) remains controversial especially in pediatric urology. Debate continues in regarding the advisability of immediate repair versus delayed repair. The aim of this study was to analyze our experience in the outcomes of immediate and delayed repair of pelvic fracture urethral distraction defects in young boys.

METHODS

We retrospectively reviewed the records of 210 boys with posterior urethral disruption after pelvic injury between 1992 and 2012. Exclude partial urethral injury, a total of 177 cases acquired follow-up. All patients were evaluated by plain radiography, ultrasonography, or a computed tomography scan to assess the conditions of the upper urinary tract and to exclude other severe injuries. Data on 35 patients who underwent immediate repair were compared to those on 142 treated with delayed urethroplasty. After the diagnosis of a complete urethral injury, the immediate repair group underwent urethroplasty via the perineal approach if the patient's condition was stable, and serious complications were treated. The delayed repair group patients with the delayed urethroplasty average 6 months after injury. All patients were evaluated postoperatively for urethral strictures, incontinence and impotence. The patients were assessed by uroflowmetry and renal ultrasonography with evaluation of the postmictional residue every 3 months during the first year of follow-up. We assessed incontinence and erectile function by questioning the parents or the children themselves. Statistical analysis with the chi-square test was performed using SPSS software.

RESULTS

One hundred and seventy-seven patients were followed up with an average 58 months (range 6 to 192 months). Strictures developed in 3 (9%) patients in immediate repair group; two required direct visual internal urethrotomy (DVIU), the other patient required dilatation. Strictures developed in 11.9% of the delayed repair group, 17 patients need visual internal urethrotomy or urethroplasty. Incontinence (11.4%) and impotence (8.6%) seem less frequent in the immediate repair group than in the delayed reconstruction group (17.7% and 21.8%, respectively). However, the results showed that there was no statistical difference between the two groups in strictures after first surgery, incontinence and impotence. Patients with delayed reconstruction underwent an average of 2.6 procedures compared with an average of 1.1 in the immediate repair group.

CONCLUSIONS

Immediate repair of urethral disruption is possible when the patient's condition was stable. It may decrease the requirement for subsequent urethral surgeries. Immediate repair does not appear to increase the rate of impotence or incontinence. The strictures after immediate repair also may be easier to treat. Although immediate repair could be inconvenient in the massively injured patient, it is still a worthwhile maneuver in dealing with PFUDD.