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A ruptura uretral iatrogênica geralmente é uma intercorrência secundária à passagem forçada de sondas rígidas durante a tentativa de desobstrução uretral; procedimento este realizado como forma de eliminação imediata da urina em casos de retenção aguda, a fim de proporcionar maior conforto ao animal e melhoria das condições clínicas. Felinos são frequentemente acometidos por distúrbios urinários e a uretrostomia é a intervenção cirúrgica indicada quando a tentativa de desobstrução não tem sucesso ou quando o animal apresenta constantes recidivas. O presente estudo tem como objetivo demonstrar o uso de uma técnica de desvio urinário temporário em felino com ruptura de uretra, feito a partir da inserção de uma sonda tipo Foley na região ventral da bexiga e fixação desta à parede abdominal para que a urina pudesse ser conduzida ao meio externo.

Background Girls’ pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap. Methods We retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients’ trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior ureth roplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children. Results Operation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period. Conclusions Our method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.

OBJECTIVE To evaluate the feasibility of buccal mucosal graft urethroplasty for repairing complete urethral rupture in cats. ANIMALS 15 male domestic shorthair cats with traumatic complete urethral rupture. PROCEDURES In each cat, a section of buccal mucosa was harvested, sutured, and formed into a tubule by use of an 8F indwelling catheter as support. This tubular graft was connected to both ruptured ends of the urethra to renew the urinary passage. The catheter was left in place until the absence of leakage was confirmed by positive contrast retrograde urethrography. After spontaneous urination was confirmed, cats were discharged from the hospital. Six months later, urethrography was repeated and owners were asked to score their cats’ urinary function and quality of life. RESULTS 13 cats recovered well following surgery, with no complications in the oral cavity or surgical site and no signs of difficulty or discomfort when urinating. Urethrography 2 weeks and 6 months after surgery revealed no stricture or leakage in the abdominal cavity. The 2 remaining cats developed a urethral stricture and underwent second surgery with a successful outcome. At the 6-month follow-up, 14 cats had only mild urinary signs, and 1 cat had incontinency. Owners indicated they were delighted (n = 14) or pleased (1) with their cats’ quality of life. CLINICAL RELEVANCE Buccal mucosa was found to be a good source of graft tissue for performance of urethroplasty in male cats, yielding satisfactory outcomes with few postoperative complications. The described technique may be suitable for severe and complicated cases of urethral rupture in male cats.

Traumatic testicular dislocation is a rare complication secondary to different kinds of accidents. A 61-year-old man, who was injured by wall collapse and was diagnosed as pelvic fracture and posterior urethral rupture 5 months ago, came to the urologic department to seek urethral reconstruction. However, thorough physical examination and imaging examination confirmed a round mass in the right inguinal region and an empty right scrotum, which support diagnosis of testicular dislocation. The patient did not take the initiative to complain about that because he thought the right testis had been destroyed by the accident already. So the patient underwent fiber cystourethroscopy, urethral reconstruction, and orchiopexy. No testicular atrophy was confirmed at follow-up. We reviewed previous reports about traumatic testicular dislocation and analyzed the cause of delayed diagnosis.

Purpose: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. Methods: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200-10,000 mL, with an average volume of 2850 mL. Postoperative follow-up ranged from 6 months to 1.5 years. Results: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy. Conclusion: The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory. Key words: Multiple trauma; Pelvic fractures; Internal iliac artery; Consumptive coagulopathy; Hemostasis

Penile fracture is a rare urologic emergency. The main finding is a partial disruption of one or both cavernosal bodies due to blunt trauma of the penis during an erection. Complete or partial injury of the urethra may accompany the penile fracture but complete urethral rupture is rarely encountered. In this study, we present the management of a penile fracture case with disruption of both corpus cavernosum with total urethral rupture.

Highlights • About 10% of traumatic injury patients have genitourinary involvement. • Immediate exploration and urethral reconstruction is indicated in urethral trauma. • Urethra rupture with anorectal laceration can be treated with primary anastomosis., Introduction The initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture’s location and length as well as the accompanying trauma. Case presentation A 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. There was a laceration to the perineum 3 cm long to the rectum, with no active bleeding. After the incident, the patient could not void, but the lower abdomen was not painful. Upon retrograde urethrography examination, contrast extravasation of the bulbous urethra was seen through the anorectal laceration. Immediate debridement and repair for the anorectal wound, then primary anastomosis for the bulbous urethra, was performed. Discussion The likelihood of an injury to the anterior urethra increases with certain clinical features, including blood in the urethral meatus, palpable bladder distention, and a butterfly appearance on the perineum. Immediate exploration and reconstruction of the urethra is recommended in urethral traumas associated with penile fractures and non-life-threatening penetrating injuries. Furthermore, small lacerations are repaired primarily, while total ruptures are treated with anastomosis. Conclusion Proper identification and management of urethral rupture determines the outcome. Initial urethral trauma management is disputed; however, a bulbous urethra rupture with anorectal lacerations can be treated safely and effectively with primary anastomosis.

Introduction: Penile fracture with rupture of the urethra is a rare and underreported case in Urology. We present this case received at the Emergency Department of Urology at the State University Hospital of Haiti. Case Study: A 49 years old man was seen with a 6 hours history of urethrorrhagia with pain and deformation of the penis. The symptoms occurred following sexual intercourse with use of a stimulant in a doggy style position. The patient was taken to the OR 12 hours after presentation, a circular incision was initiated through the balanopreputial groove to deglove it to the root. A wound of the corpus cavernosum at 2.5 cm from the meatus was noted with a partial anterior urethral injury about 3 cm in length. Conclusion: The diagnosis of penile fracture is essentially clinical and does not require imaging. Urgent surgical management is necessary to reduce the risk of long-term complications.

A 3-month-old male DSH cat was presented with a history of lethargy, anorexia, dysuria, urinary incontinence, dermatitis and swelling in the perineal area following a road traffic trauma. Retrograde positive-contrast urethrography revealed an intra-pelvic urethral rupture which was managed by performing transurethral catheterisation. Due to accidental removal, the case was presented for re-examination following a progressive urine scald dermatitis several days later. So, surgical placement of cystostomy tube was performed. The cat regained his ability to urinate normally a week later and the catheter was withdrawn. The extensive perineal dermatitis due to urine scald necessitated delayed primary closure. Topical and systemic antibiotics were administered for 2 weeks and second intention wound healing was completed after 5 weeks.

We herein report a rare case of nontraumatic urethral rupture. The patient presented with oliguria, perineal pain and anorexia, and a 3 cm fistula was located in the perineum. Computed tomography revealed a retroperitoneal abscess invading the urethra, and a retrograde urethrogram revealed the rupture of the membranous urethra. He had no history of perineum trauma or transurethral procedures. Although he underwent a suprapubic cystostomy and conservative therapy by antibiotics, he eventually died.

A variety of retrievable and other types of temporarily placed stents are currently being used. However, only a few studies have considered primary endoscopic realignment with temporary urethral stent insertion in the event of traumatic bulbar urethral injury. We aimed to compare the clinical effectiveness and complications between thermo-expandable urethral stents and polymer-coated bulbar urethral stents (BUSs) for the treatment of traumatic bulbar urethral strictures. Between September 2011 and March 2018, 30 patients who had been diagnosed with complete bulbar urethral rupture following blunt trauma underwent temporary urethral stent placement after primary realignment. Thermo-expandable nickel-titanium alloy urethral stents were placed for 15 patients (group M), and retrievable self-expandable polymer-coated BUSs were placed for another 15 patients (group A). All stents were removed within 6 months after placement. The complications and maintained patency rates were compared between the two groups. The mean stent indwelling period was 5.0 ± 2.5 months in group M and 4.9 ± 4.0 months in group A. Both groups maintained high patency rates (Group M 12/15 (80.0%) and group A 13/15 (86.7%)). Five patients who developed urethral stricture underwent direct visual internal urethrotomy (DVIU), and no patients required repeat DVIU or open surgical urethroplasty. Both groups maintained the mean maximal urinary flow rate (Qmax) at 12 months after stent removal. Discomfort (46.7% vs. 6.7%), granulation tissue formation (73.3% vs. 26.7%) and post-void dribbling (80.0% vs. 20.0%) were more frequent in group M than in group A (p = 0.013, p = 0.011 and p = 0.001, respectively). In conclusion, both stents were effective for managing traumatic complete bulbar urethral rupture after primary realignment. However, the thermo-expandable urethral stents had a higher complication rate while the stent was in situ than the BUSs.

Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: “penile fracture”, “fracture of penis”, “trauma to penis”, “rupture of corpora cavernosa”, “urethral injury”, “urethral rupture” and “urethral reconstruction”. Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.

peer-reviewed Data on urethral catheter related injuries is sparse. In this study we aimed to characterise urethral diametric strain and urinary catheter inflation pressure thresholds that precede human urethral trauma during urethral catheterisation (UC). Human urethras were obtained from patients undergoing male to female gender reassignment surgery [(n = 9; age 40 ± 13.13 (range: 18–58)) years]. 12Fr urinary catheters were secured in the bulbar urethra and the catheter's anchoring balloon was inflated with a syringe pump apparatus. Urethral diametric strain and balloon pressure were characterised with video extensometry and a pressure transducer respectively. Immunohistochemistry, Masson's trichrome and Verhoeff-Van Gieson stains evaluated urethral trauma microscopically. Morphological characterisation of the urethral lumen was performed by examining non-traumatised histological sections of urethra and recording luminal area, perimeter and major/minor axis length. Tearing (n = 3) and rupture (n = 3) of the urethra were observed following catheter balloon inflation. The threshold for human urethral rupture occurred at an external urethral diametric strain ≥ 27% and balloon inflation pressure ≥ 120kPa. Significant relationships were identified between urethral wall thickness and the level of trauma induced during catheter balloon inflation (p = 0.001) and between the pressure required to inflate the catheter balloon and the length of the major axis of the urethral lumen (p = 0.004). Ruptured urethras demonstrated complete transection of collagen, elastin and muscle fibres. In conclusion, urethral rupture occurs at an external urethral diametric strain ≥ 27% or with balloon inflation pressures ≥ 120 kPa. Incorporation of these parameters may be useful for designing a safety mechanism for preventing catheter inflation related urethral injuries.

Complete disruption of the urethra due to penile fracture is a very rare occurrence. Herein, we report a case of a 39-year-old man who presented with penile fracture and complete disruption of the urethra as a result of sexual intercourse and present a review of the literature on penile fracture. Surgical exploration at presentation was performed and primary repair was done. In follow-up, the patient reported moderate erectile dysfunction which over time responded to phosphodiesterase-5 inhibitor drugs. Early surgical repair and evaluation for concomitant urethral injury in case of penile fracture is highlighted in this report.

Posterior urethral injuries typically arise in the context of a pelvic fracture. Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected. Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first. Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury. Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3–6 months continues to be the gold standard of treatment. In this paper, we provide a comprehensive review of the literature with a special emphasis on the various treatments available: Open or endoscopic primary realignment, immediate or delayed urethroplasty after suprapubic cystostomy, and delayed optical urethrotomy. Keywords: Posterior urethral injuries, Distractions defects, Pelvic fracture, Realignment, Urethroplasty, Optical urethrotomy

Made available in DSpace on 2022-04-28T19:06:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-03-01 Abdominal urethral rupture commonly occurs in male dogs after traumatic pelvic fractures and can lead to uroperitoneum, causing peritonitis and azotemia. The primary complications of urethral damage include strictures, incontinence and innervation injury. Here, we describe a case report of prostatic urethral rupture, treated by primary suture repair, that yielded early healing and recovery in a ten-year-old, male, mixed-breed dog who visited our facility within 24 hours of being struck by a car. Positive contrast urethrocystography resulted in leakage of the contrast medium into the abdominal cavity in a point caudal to the urinary bladder. Additional radiography revealed multiple pelvic fractures. During surgery, we found a laceration of the right prostatic lobe causing urethral rupture. We performed a full thickness simple continue suture with 7-0 polyglactin 910 to reestablish urethral continuity. The prostate capsule was also sutured in a simple continue pattern. A previously placed indwelling urinary catheter was kept inside to divert urine flow. On the third postoperative day, the animal withdrew the urinary catheter and started to urinate by himself. The conservative treatment of pelvic fractures enabled complete return to function on the 55th day. One hundred and fifty days after the trauma, no evidence of urinary stricture or another clinical sign was observed. Urethral wounds can be treated surgically by primary suturing and urinary diversion. A short healing time was experienced, and the indwelling urinary catheter was removed three days after surgery since there was no more urine leakage and the animal began voiding normally. Departamento de Cirurgia e Anestesiologia Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho Departamento de Cirurgia e Anestesiologia Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho

Penile fracture is a rare urological emergency caused by blunt trauma to the erect penis and it may be accompanied by urethral injury. Complete urethral rupture is very uncommon and is usually managed by primary anastomosis. However, these patients are more likely to develop post-operative complications such as urethral strictures. Buccal mucosa graft is commonly used for substitution urethroplasty in management of urethral strictures, but its use has not been reported for immediate treatment in the setting of penile fracture. We report a patient with rupture of both corpora cavernosa, as well as the rupture of the urethra, after sexual intercourse. Buccal mucosa graft was used for surgical repair of urethral injury. At 36-month follow-up patient did not experience erectile or voiding problems. The application of this technique could possibly reduce the incidence of urethral strictures in these patients and further prospective studies with larger samples should be conducted.

Introduction: Traumatic stricture urethra is a rare entity, with surgery being the only treatment modality. We aim to evaluate and analyse the surgical outcomes and erectile function in patients who undergo surgical treatment for traumatic urethral stricture disease at our institution. Material and Methods: A prospective study was conducted on 57 male patients who presented between Aug 2015 and Dec 2017 in our institution, with post traumatic stricture urethra. The urethral rupture was confirmed by RGU and patients underwent suprapubic catheterisation initially. At 3 months these patients underwent delayed anastomotic urethroplasty. The patients were followed up for 6 months- 24 months. Erectile function was assessed by IIEF-5 questionnaire pre operatively and post-operatively at 6 months. Results: Mean age of patients was 38.5 years. Majority of the patients (36.84%) were between 21 to 30 years of age..Majority of the patients (32) had road traffic accidents (indirect) and 12 patients had history of fall/direct trauma to perineum or urethra. Twelve (21.05%) patients developed complications postoperatively. Early complications of wound infection occurred in 08 (14.03%) patients. Late complications were seen in 12 (21%) patients i.e. restenosis. Erectile dysfunction is seen in 42.11% patients at the end of six months. Overall surgical success rate was 78.9 % at 6 months. Conclusion: Delayed anastomotic urethroplasty is an effective procedure for traumatic urethral strictures with good surgical results. Recurrence of stricture is most common complication. But, surgical procedure leads to some degree of erectile function.

Background : Serious urethral damage or recurrent obstructions in felines require a urethrostomy to provide a return to and maintenance of urinary flow. In some cases, urethral reconstruction with complementary tissue is required. Grafting of autogenous vascularized intestinal segments is widely used in human medicine to promote the functional restoration of the urethra, but in veterinary medicine, its use is still incipient. Thus, the aim of this report was to analyze and describe the use of thein functional urethral repair in a feline diagnosed with a severe urethral rupture. Case : A castrated male cat presented with urethral obstruction. Emergency decompression cystocentesis was performed, and fluids and analgesics were administered. Catheterization and urohydropropulsion were attempted to relieve the obstruction, without success. An emergency perineal urethrostomy was indicated. After the procedure, the diagnosis (obstructive lower tract urinary disease) and the infeasibility of restoring urinary flow by conventional urethrostomy techniques were confirmed. We opted for a laparoscopic-assisted prepubic urethrostomy; the pre-prostatic urethra was transected, and its caudais end was brought through an abdominal incision cranially. However, urethral tension was noted after this maneuver was performed. Thus, we decided to use autogenous vascularized intestinal segment grafting for urethral reconstruction. A segment of the ileum was prepared for grafting, with preservation of irrigation and mesenteric innervation. A termino-terminal anastomosis was performed on the stumps of the remaining intestine, and the mesentery was sutured. The ileal graft was isolated and washed to remove luminal content. A tunnel was made in the abdominal muscles, subcutaneous tissue, and skin of the prepubic region; the cranial end of the intestinal graft was passed through this tunnel. A Foley catheter was passed through the graft, in sequence in the remaining urethra and urinary bladder. The luminal size difference between the caudal end of the graft and urethra was corrected by wedge-shaped cut, and a suture was made. Repair points were made between the caudal end of the graft and urethra across the entire circumference. The knots were then executed. Suturing of the abdominal wall was routine. To make the ostomy, the end border of the graft was externalized, and the antimesenteric border was cut and sutured to the skin. Finally, a Foley catheter was attached to the skin. The cat was kept in the hospital for 72 hours and then discharged. Regular clinical assessments took place for a year following the operation. Discussion : Transoperative maneuvers for obtaining and applying the graft were feasible, of medium complexity, and suitable for maintaining vitality of the grafted segment of tissue and restoring immediate urinary flow. Regular clinical evaluations over the course of a year, as well as ultrasonography and tomography of the urinary tract in the first half of the year, proved the effectiveness of the grafting technique; the cat’s urinary flow was normal, and there were no signs of rejection to the intestinal graft. We conclude that an autogenous graft of vascularized intestinal segments is a good urethral substitute and has significant therapeutic value for cases in which urethral reconstruction is necessary, particularly when other surgical techniques are not feasible.

La fracture du pénis est une urgence urologique rare, définie comme une rupture traumatique de la tunique albuginée du corps caverneux. Elle touche essentiellement le sujet jeune au cours de l'activité sexuelle. Le but de ce travail était de rapporter les résultats de la prise en charge de 06 cas de fracture de verge observés dans le service d'Urologie-Andrologie du Centre Hospitalier Universitaire Sanon Souro (CHUSS) de Bobo-Dioulasso. Il s'agissait de six patients d'âge moyen de 38,3 ans, reçu pour tuméfaction douloureuse de la verge pour 04 cas et d'urétrorragie persistante pour 02 cas au décours de faux pas du coït ou de manipulation forcée de la verge. La tuméfaction douloureuse de la verge avec la verge en “aspect d'aubergine” a été le principal signe retrouvé. Le traitement a consisté en une évacuation de l'hématome intra-caverneux suivi d'une albuginorraphie pour 05 cas et pour un cas d'un traitement conservateur. Les suites opératoires ont été simples pour l'ensemble des patients.

Background: Management of partial or complete traumatic urethral disruptions of the posterior urethra in children and adolescents, secondary to pelvic fracture poses a challenge. Controversy exists as to the correct acute treatment of posterior urethral injuries and delayed management of PFPUDDs. We reviewed the urological literature related to the treatment of traumatic posterior urethral injuries and delayed repair of these distraction defects in children and adolescents. Material and Methods: There are few long-term outcomes studies of patients who underwent PFPUDDs repairs in childhood; most reports included few cases with short follow up. We excluded studies in which the cohort of patients was heterogeneous in terms of stricture disease, etiology and location. Results: Primary cystostomy and delayed urethroplasty is the traditional management for PFPUIs. Immediate repair is rarely possible to perform. Realignment of posterior urethral rupture in children is indicated in special situations: (a) concomitant bladder neck tears, (b) associated rectal lacerations, (c) long disruptions of the urethral ends. Before delayed reconstruction ascending urethrography and micturating cystourethrogram along with retrograde and antegrade urethroscopy define site and length of the urethral gap. However, the most accurate evaluation of the characteristics of the distraction defect is made when surgical exposure reveals the complexity of the ruptured urethra. Partial ruptures may be managed with urethral stenting or suprapubic cystostomy, which may result in a patent urethra or a short stricture treated by optical urethrotomy. The gold standard treatment for PFPUDDs in children is deferred excision of pelvic fibrosis and bulbo-prostatic tension-free anastomosis, provided a healthy anterior urethra is present. Timing of delayed repair is at 3 to 4 months after trauma. Some urologists prefer either the perineal access or the transpubic approach to restore urethral continuity in children with PFPUDDs. Substitution urethroplasties are used in children with PFPUDDs, when anastomotic repair can't be achieved due to severe damage of the bulbar urethra. Conclusion: As evidenced in this review the progressive perineo-abdominal partial transpubic anastomotic repair has advantages over the isolated perineal anastomotic approach in patients with "complex" PFPUDD. This approach provides wider exposure and facilitates reconstruction of long or complicated posterior urethral distraction defects.