Posterior urethral injuries and the Mitrofanoff principle in children

Posterior urethral injuries and the Mitrofanoff principle in children

Author Freitas Filho, Luiz Gonzaga de Autor UNIFESP Google Scholar
Carnevale, J. Google Scholar
Melo, A. R. Google Scholar
Vicente, N. C. Autor UNIFESP Google Scholar
Heinisch, A. C. Google Scholar
Martins, Jose Luiz Autor UNIFESP Google Scholar
Institution Hosp Infantil Darcy Vargas
Hosp Santa Marcelina
Universidade Federal de São Paulo (UNIFESP)
Abstract OBJECTIVETo report our experience of children with trauma causing posterior urethral injury who at some stage underwent a Mitrofanoff intervention, as post-traumatic urethral injuries can demand long-term treatment which (regardless of the surgical intervention) requires a period of dilatation of the reconstructed urethra.PATIENTS and METHODSFrom 1992 to 2001, 14 patients with urethral injuries underwent a Mitrofanoff procedure. Thirteen had been run over by a motor vehicle and had severe hip injuries, and one had a direct non-penetrating perineal impact lesion (13 boys and one girl, aged 2-13 years at the time of the accident). in all cases the Mitrofanoff procedure involved interposing the appendix between the bladder and the umbilicus. Only one of the children (because of extremely high bladder filling pressures) also underwent an augmentation cystoplasty and closure of the bladder neck because there were bony fragments in the urethra.RESULTSThe Mitrofanoff technique was considered useful in most cases. All patients during a given period used the Mitrofanoff conduit to empty their bladder every 3 h; 10 of the 14 are currently voiding urethrally, with an adequate flow, and four are not, but emptying the bladder periodically via the appendicovesicostomy. the only girl in the group has a major hip deformity and is unlikely to undergo urethroplasty; two patients are expecting definitive treatment and the other, although having a patent urethra, has no urinary flow. He is currently 19 years old and has no erections.CONCLUSIONSThe treatment of posterior urethral injuries represents a challenge to surgical teams. Although primary suturing of the separated urethral ends is accepted as the best treatment, the construction of a temporary continent urinary diversion may be considered in the most severe cases.
Keywords urethral stricture
wounds
injuries
pelvis
fracture
catheterization
Language English
Date 2003-03-01
Published in Bju International. Oxford: Blackwell Publishing Ltd, v. 91, n. 4, p. 402-405, 2003.
ISSN 1464-4096 (Sherpa/Romeo, impact factor)
Publisher Blackwell Publishing Ltd
Extent 402-405
Origin http://dx.doi.org/10.1046/j.1464-410X.2003.04086.x
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000181228300027
URI http://repositorio.unifesp.br/handle/11600/27154

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