ABSTRACT
Aims: This study aimed to evaluate the outcome of perineal trauma in children and to a define protocol for their management. Methods: It is a retrospective study of children who presented with perineal injury between August 2012 and December 2020. The patients were classified into three groups: Group-1 included children with perineal and genitourinary injuries; Group-2 included patients with perineal and anorectal injuries; and Group-3 included patients with perineal, genitourinary, and anorectal injuries. All patients underwent primary repair. Those with full-thickness anorectal injury underwent an additional covering colostomy, while urethral disruption was initially managed by a diverting suprapubic cystostomy (SPC). Results: A total of 41 patients were studied. Impalement injury (n = 11; 27%) and sexual abuse (n = 11; 27%) were the most common mechanisms of injury. Twenty (49%) patients had anorectal injuries with 10 (24%) each of partial-thickness and full-thickness injury. There were 24 (59%) genital injuries and five (12%) urethral injuries. One patient each developed anal and vaginal stenosis, both were managed with dilatation. One patient developed a rectovaginal fistula repaired surgically at a later date. Conclusion: Perineal injuries with resultant anorectal or genital damage require a careful primary survey. Following stabilization, an examination under anesthesia as a set protocol will help determine the treatment strategy. A colostomy is essential in the acute management of severe anorectal injuries to reduce local complications and preserve continence. Urethral injuries may warrant an initial diverting SPC in selected cases.
ABSTRACT
Transureteroureterostomy (TUU) is a urinary reconstructive procedure seldom used but has a role when conventional reconstructive techniques are not possible. However, the concern is whether it places the opposite, non-diseased ureter and kidney at risk. Hence a retrospective study was conducted to evaluate indications, methods, and outcomes of transureteroureterostomy in children. The study included seven children who underwent TUU between January 2011 and December 2015. The mean age of the study group was 4.5 ± 2.9 years. Six (86%) patients were males. Two patients had primary bladder diverticulum, two posterior urethral valves, two cases of vesico-ureteric reflux, and one had a persistent urogenital sinus. All patients presented with recurrent urinary tract infections. Three (43%) patients had bladder outlet obstruction. Four (57%) patients underwent left to right TUU with right ureteric reimplantation. Two (29%) patients underwent an additional procedure. No complications were found. The key to a good outcome in TUU is case selection. Surgical technique plays a very important role in ensuring good long-term outcome without compromising the normal moiety.
