Pelvic Fracture Urethral Injury (PFUI) in 3-Year-Old Boy: A Case Report

Akmal Fawzi, Paksi Satyagraha, Besut Daryanto, Kurnia Penta Seputra

Urology Department Medical Faculty Brawijaya University Malang - Saiful Anwar General
Hospital Malang, Indonesia

Abstract
Introduction:
Pediatric PFUI is a rare case with incidence <1-5%. Boys are more likely to experience PFUI
than girls, with average age of 9 years. The mechanism mostly by pedestrians hit by motor
vehicles (71%). Due to anatomical differences from adults, the treatment requires delicate
approach. In this case we reported PFUI case in 3-year-old boy.
Case presentation:
A 3-year-old boy came with urinary retention after falling from heights while playing. After the
accident bloody urethral discharge was found. There was pubic-rami pelvic fracture from
radiology examination and the patient underwent suprapubic cystostomy. He came 5 months
after the initial injury with membrano-prostatica urethral stricture shown from MCU-RGU.
Antegrade and retrograde urethroscopy revealed total membrano-prostatica urethral
stricture. We performed posterior urethoplasty. Bulbar urethral was mobilized and
spatulated, crural separation was need to be performed to achieve no tension anastomosis.
The urethral catheter was removed 3 weeks after surgery and patient could void normally. 6
months evaluation shows patent urethra shown by RGU. Based on uroflowmetry study 1
years after operation, Qmax was 18,5 ml/s and voided volume was 84 ml and no voiding
complain occured.
Conclusion:
Treatment of PFUI has its own difficulties in children compared to adults where in children
the injuries become more complicated because of the anatomical condition that are still
developing. However, end to end anastomotic urethroplasty produce satisfiying result in this
patient and can be suggested for other similar cases in the future.
Keywords: PFUI, Pediatric, End to End Anastomosis Urethroplasty