A new alternative for management of urethral transection in young girl

Abstract

Background: Pediatric female urethral injury is rare and the management remains non consensual. Patients presenting at a later stage with obliterate strictures have limited surgical options for repair. The aim was to report an original endosurgical procedure to recreate the urethra after a complete urethral rupture Case presentation: A 6-year-old girl was operated for a ruptured bladder. The attempt to catheterize the urethra failed. We decided to put a suprapubic cystostomy. Cystourethrography, performed 3 weeks postoperatively, showed a complete urethral rupture. The patient was lost to follow-up for 2 years. When returned, the decision was to perform urethra realignment endoscopically with a suprapubic and transurethral approaches. When brought in by the cystostomy, the endoscope showed a normal bladder wall and a stricture of the bladder neck. When introduced by the remaining urethra, it showed a dead-end 1- cm urethra. The intervention consisted on drilling the way from the meatus, to reach the bladder, while controlling the procedure by suprapubic cystoscopy. The result was a urethral path of 1.5cm permitting a normal voiding behavior after the closure of the suprapubic opening. Conlusion: Post traumatic urethral injury in girls is difficult to deal with. Surgical ingenuity and more preservative techniques are necessary and go along with maintaining an acceptable urinary function.

Keywords

• Injury
• Girls
• Urethral stricture
• Rupture
• Pelvic fracture
• Case report