Updates in the Treatment of Urethral Injuries in Children

Because of the immature pelvis and relatively intra-abdominal position of the child’s bladder, children with a posterior urethral injury will differ from adults with this injury in four ways. First, a pelvis fracture is more likely to be unstable and associated with a severely and permanently displaced prostatic urethra. Second, the severe displacement of the prostate off the pelvis floor makes a completeposterior urethral disruption more common in boys than in men. Third, concurrent bladder and urethral injuries may occur in up to 20% of pediatric patients following this injury as a result of anterior longitudinal tears through the bladder neck and sphincteric complex being two fold more common in children compared with adults. Fourth, in prepubertal girls, pelvic fractures are four times more likely tobe associated with a urethral injury than in adult women.The clinical impact of these differences is noteworthy. Permanent displacement of the prostate off the pelvis floor results in an increased need for either a transpubic, trans symphyseal, or combined transpubic and perineal dissection for urethral reconstruction compared with adult patients. Hypothetically, the severe displacement of the prostate off the pelvis floor raises concern that erectile dysfunction will be more common in children sustaining a urethral injury than in adults. There is also apprehension that permanent urinary incontinence may be more likely in children following this injury as a result of the increased risk of the combined injuries to the posterior urethra, bladder neck, andsphincteric complex.Consideration for a urethral injury should arise any time a patient presents with a history of direct trauma to the penis, vagina, perineum, or pelvis. We present the various types of urethral injuries in children and their update management.