ABSTRACT Objective: This case report aims to describe a different approach of PFUI by conservative management that resulted in good outcome. Case(s) Presentation: A 7-year-old girl patient was brought to the emergency department after falling from public transportation diagnosed with suspicious urethral rupture, perineal rupture grade III, vertical-shear type pelvic-ring injury, laceration wound on the right lower leg, abrasion on the medial side left lower leg and urinary retention. The patient underwent percutaneous cystostomy, pelvic bandage, a perineal debridement and repair, a cystography, percutaneous vesicolithotripsy, cystostomy and synechiae incision. One year after the first admission it was planned for urethroplasty due to completely obliterated from antegrade and retrograde panendoscopy. Discussion: 8 months later urethroplasty was aborted because of an open bladder neck, a fistula at the anterior connected to the distal of the bladder neck with size of 3 mm. The patient was performed a silicon cystostomy catheter insertion for 6 weeks. At the time of evaluation, the fistula was closed, it was proven by Qmax uroflowmetry was 18ml/s with average flow: 9.8 ml/s, voiding volume: 90ml, flow time: 9s, voiding time: 9s, hesistance:1.5, and PVR:5.35 cc. Conclusion: In this case, it showed that conservative management could improve PFUI with satisfactory result, proved by good result of uroflowmetry. However, periodic evaluations must be carried out to follow the progress of the disease and the possibility of future complications including sexual function. Keywords: PFUI, girl, urethral rupture
PFUI, girl, urethral rupture
Barratt RC, Bernard J, Mundy AR, Greenwell TJ. Pelvic fracture urethral injury in males- mechanisms of injury, management option and outcomes. Transl Androl Urol. 2018; 7: S29-S62.
Pichler R, Fritsch H, Skradski V, Horninger W, Schlenck B, Rehder P et al. Diagnosis and Management of Pediatric Urethral Injuries. Urologia Internationalis. 2012; 89(2): 136-142.
Patel DN, Fok CS, Webster GD, Anger JT. Female urethral injuries associated with pelvic fracture: a systematic review of the literature. BJU international. 2017 Dec; 120(6): 766-73.
Dorairajan LN, Gupta H, Kumar S. Pelvic fracture‐associated urethral injuries in girls: experience with primary repair. BJU international. 2004 Jul; 94(1):134-6.
Bryk DJ, Zhao LC. Guidline of guidelines: A review of urological trauma guidelines. BJU Int. 2016; 117: 226-34.
Martins FE, Kulkarni SB, Köhler TS, editors. Textbook of male genitourethral reconstruction. Springer; 2020.
Khattar N, Nayyar R, Panda A. Female Bladder Outlet Obstruction and Urethral Reconstruction. Springer Singapore; 2021.
Delaney K, Reddy S, Dayama A, Stone M, Meltzer J. Risk factors associated with bladder and urethral injuries in female children with pelvic fractures. Journal of Trauma and Acute Care Surgery. 2016; 80(3): 472-476.
Hagedorn JC, Voelzke BB. Pelvic-fracture urethral injury in children. Arab journal of urology. 2015 Mar 1; 13(1): 37-42.
Kitrey ND, Djakovic N, Hallscheidt P, Kuehhas FE, Lumen N, Serafetinidis E, Sharma.DM. EAU guidelines on urethral trauma. European urology. 2021; 21-28.
Mundy AR, Andrich DE. Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management. BJU international. 2011 Aug; 108(3): 310-27.
Elbakry A. Classification of pelvic fracture urethral injuries: Is there an effect on the type of delayed urethroplasty?. Arab journal of urology. 2011 Sep 1; 9(3): 191-5.
Gomez RG, Mundy T, Dubey D et al. SIU/ICUD consultation on urethral strictures: pelvic fracture urethral injuries. Urology 2014; 83: S48–58
Waaldijk K. The immediate management of fresh obstetric fistulas. American Journal of Obstetrics and Gynecology. 2004 Sep 1;191(3): 795-9.
Tayler-Smith K, Zachariah R, Manzi M, et al. Obstetric fistula in Burundi: a comprehensive approach to managing women with this neglected disease. BMC Pregnancy Childbirth 2013;13: 164
Davits RJ, Miranda SI. Conservative treatment of vesicovaginal fistulas by bladder drainage alone. British journal of urology. 1991 Aug; 68(2): 155-6.