Long-term continence outcomes after immediate repair of pediatric bladder neck lacerations extending into the urethra.

摘要

PURPOSE: Traumatic bladder neck lacerations extending into the urethra are devastating injuries that occur more commonly in children than in adults. It is unclear whether immediate repair of these injuries decreases long-term complications, such as urinary incontinence. We report our long-term results with immediate operative repair of these injuries. MATERIALS AND METHODS: Since 1986, we have primarily repaired all individuals sustaining traumatic longitudinal bladder neck lacerations extending into the urethra within 24 hours of injury. All patients were followed a minimum of 2 years. RESULTS: A total of 12 patients 2 to 16 years old sustained longitudinal bladder neck lacerations extending into the proximal urethra. Median followup was 7 years (range 2 to 13). Postoperatively none of the 12 patients recovered complete urinary continence. Periurethral bulking agents were attempted in all 12 patients with no long-term improvement. Eight patients (75%) pursued additional surgery. Three boys underwent artificial urinary sphincter placement, of which all subsequently eroded. Three girls underwent bladder neck reconstruction with fascial sling procedures, of whom 2 became continent but experienced urinary retention, while 1 became partially continent. Five patients, including the 3 boys with artificial urinary sphincter erosion, ultimately underwent bladder neck closure and continent diversion. CONCLUSIONS: Traumatic longitudinal bladder neck and proximal urethral lacerations are devastating injuries fraught with long-term complications and the need for additional surgery despite immediate surgical repair. Bladder neck closure and continent diversion should be considered in girls with substantial traumatic urethral loss and in boys with persistent urinary incontinence following primary repair.