Approach to the Patients with Disruption of Bladder Neck and Concurrent Trauma to Sacral Nerve plexus after car accident in Mofid children hospital

Introduction:Trauma to the bladder neck and disruption of posterior urethra is very rare and serious. Incontinency and stenosis of urethra is in about 50% of these patients after surgery. In this study, we considered urine incontinency and stenosis of urethra particularly with concurrent trauma to sacral nerve plexus and we propose a way for treatment of these patients.Methods:In this study, we had 4 patients between 1395 to 1398 in Mofid children hospital that all of them were boys and in pre school age. All of them had blunt abdominal trauma with disruption of bladder neck and concurrent trauma to sacral nerve plexus after car accident. We have done explorative laparotomy with suprapubic cystostomy and realignment of urethra with catheter for about 3-4 weeks.After dislodgment of catheter all of them had incontinency along day and night. In our studies such as cystoscopy and urethrography all of them had stenosis in repair site, and in EMG-NCV had damage to sacral plexus and bladder neck innervation. So, in order to concurrent stenosis and sacral plexus damage we have done Mitrofanoff procedure in 3 patients.Results:In this study we had 4 cases (boy) that all of them had disruption of bladder neck and concurrent trauma to sacral nerve plexus after car accident. In these patients, we have done realignment of urethra. All of them had urine incontinency after dislodgment of catheter. In 3 patients we did Mitrofanoff procedure and one of them refused from this technique.Conclusion:According to this study, we suggest that in such patients with disruption of bladder neck and concurrent sacral nerve damage, it is better to do Mitrofanoff technique in order to prevention of urine in continency. Of course, it is better to do more studies with more cases in future.