الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
 |  | from | 95 |  |  |
| | | from | 95 | | |
Abstract
The incidence of PFUI in boys was found to be less than 1% in the largest series of pediatric pelvic fracture [1]. A pelvic fracture in a child indicates a high-impact trauma that is commonly associated with multiple life threatening concomitant injuries [2]. The long term sequelae of PFUI include urethral stricture, urinary incontinence and ED [2]. Due to the relative infrequency of pediatric PFUI compared to adults, management of such injuries remains controversial. The aim of this study was to evaluate the success rate of primary urethral realignment (after one trial of later endoscopic dilatation) and if it can eliminate the need for urethroplasty in children with PFUI, in addition to the surgical outcome of urethroplasty in children in the PRE group compared to children in the SPC group. We conducted this prospective randomized comparative trial on male children (less than 18 years) presented/referred to Assiut university hospital with PFUI, during the time period from (May 2018 to July 2020). After hemodynamic stabilization, immediate percutaneous suprapubic cystostomy was done for all patients under local anesthesia. Patients were enrolled into 2 groups; group (A) patients underwent PRE, while patients in group (B) were kept with the suprapubic tube only. A single trial of endoscopic dilatation was done later for all patients in the PRE group. Then, realignment was considered unsuccessful if the child had urinary difficulty, high PVR on abdominal ultrasound and/or flat uroflowmetry curve. For obstructed cases with previous PRE and for patients in the SPC group, RUG with voiding film was done (at least 3 months post-trauma), and patients were arranged for transperineal urethroplasty. Follow-up (1, 3 and 6 months post urethroplasty) was based on history (adequacy of voiding), ultrasound PVR calculation and uroflowmetry. RUG was done in cases with urinary difficulty, high PVR and/or flat uroflowmetry curve. Urethroplasty was considered unsuccessful if the patient needed more than one endoscopic dilatation post-urethroplasty. A total of 40 patients were included in the study (20 patients for each group). The (mean ± SD) patient age was (11.3 ± 4.2 years). Primary realignment did not eliminate the need for urethroplasty in all cases even after single trial of endoscopic dilatation. There was no statistically significant difference between the two groups regarding the radiological length of distraction defect (p = 0.21). Transperineal urethroplasty was done as a definitive management for all patients in the study. There was no statistically significant difference between the two groups regarding operative time of urethroplasty, estimated blood loss during urethroplasty, the need for inferior pubectomy or intraoperative complications. Urethroplasty failed in 6 patients (3 patients in each group) with overall success rate of 85%. There was no statistically significant difference between the two groups regarding postoperative complications, length of hospital stay, Q.max and continence status. Children in the PRE group were exposed to significantly more procedures and take significantly longer time to achieve normal voiding than those in the SPC group (p = 0.001).