Background

Blunt trauma to the paediatric pelvis is associated with urethral rupture, sometimes even without a bony fracture. While such rupture of the male urethra has received considerable mention, female urethral injury is both less common and has received less attention.

Objective

We describe 4 cases of urethro vaginal injury associated with pelvic fracture, its varied presentations and the modalities employed in its management.

Patients and methods

A retrospective study was done to identify 4 patients who presented to our institution between 2007 and 2018. All 4 girls suffered a loss of a urethral segment ranging from the distal urethra (n = 2) to complete urethral loss (n = 2) and rupture of the bladder neck in one. All 4 girls also had associated vaginal injury resulting in varied clinical presentation including total urinary incontinence, urocolpos, vaginal voiding via an acquired hypospadias and urinary retention with late onset haematocolpos. All were managed initially with SPC and three of them underwent urethral substitution with Monti ileal tube in two and vestibular mucosal flap in one. The hypospadiac neo-meatus was continent and was left alone. The ruptured vagina was repaired by rectus muscle interposition, direct suturing, posterior vaginal U flap or colonic patch. An appendicular Mitrofanoff was added for safety in 2 girls.

Results

Follow up was done till June 2019 (range 1–12 years). All patients voided satisfactorily and were fully continent. Normal menstrual function was present in the 3 post pubertal children.

Conclusion

A traumatic force capable of causing urethral injury may often result in associated vaginal injury and should not be overlooked. Thus urinary retention is not the only presentation of urethral injury in girls. Fistulation to the vagina may result in continent or incontinent vaginal voiding if the vagina has not been transected and urocolpos/haematocolpos in those with vaginal transection. Various modalities maybe employed to maintain continuity of the urethra and vagina including use of bowel and local flaps.

中文翻译：

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与盆腔骨折相关的尿道阴道损伤-临床表现和治疗范围。

背景

小儿骨盆的钝性创伤与尿道破裂有关，有时甚至没有骨性骨折。尽管男性尿道破裂已引起广泛关注，但女性尿道损伤既不常见，也很少受到关注。

目的

我们描述了4例与盆腔骨折相关的尿道阴道损伤，其多样的表现以及在治疗中采用的方式。

患者和方法

进行了一项回顾性研究，确定了在2007年至2018年间向我们机构就诊的4名患者。所有4名女孩均经历了尿道段的丢失，从尿道远端（n = 2）到完全尿道丢失（n = 2）直至破裂。膀胱颈合二为一。所有4名女孩还伴有阴道损伤，导致各种临床表现，包括总尿失禁，尿漏，通过后天尿道下裂引起的阴道排尿和尿毒症伴迟发性出血性尿漏。所有患者最初均采用SPC进行治疗，其中三例接受蒙蒂回肠管的尿道置换，二期进行前庭黏膜瓣的置换。尿道下裂的新肉是大陆，并且被单独放置。通过直肌插入，直接缝合，阴道后U瓣或结肠修补来修复破裂的阴道。

结果

随访至2019年6月（范围1至12年）。所有患者均令人满意地排空，并完全进入大陆。3名青春期后儿童的月经功能正常。

结论

能够引起尿道损伤的外伤力通常会导致相关的阴道损伤，因此不应忽视。因此，尿retention留并不是女孩尿道损伤的唯一表现。如果未横切阴道以及阴道横断患者中的尿囊/血球囊，则阴道造瘘可导致大陆或尿失禁。可以采用各种方式来维持尿道和阴道的连续性，包括使用肠和局部皮瓣。