INTRODUCTION AND OBJECTIVES: We aim to highlight innovative ideas in treatment of Genitor-urinary injuries in girls through our experience of 17 years. Use of intestinal segments for urethral substitution is presented. We have shown that continence can be preserved and permanent diversion can be avoided. Use of transanorectal sagittal approach for complex cases is also highlighted.

METHODS: Fourteen girls (3-17 years) were operated for genitor-urinary injuries over 17 years (1992-2009). The mechanism of injury was road accident (7), sexual abuse (5), fall (1) and iatrogenic (1). The specific injuries were: bladder neck / urethral stricture (7), urethrovaginal fistula (1), recurrent iatrogenic Vesico-vaginal fistula (1), Vaginal /perineal body injury (4), Traumatic vulval fibrosis with uremia and pyometra (1). Strictures were complicated by fistulation to vagina or rectum or both in three cases.

Following operations were performed:
Anastomotic Urethroplasty (5), urethral substitution by Monti ileum (1), total repair of rectum ,vagina and urethra (1), perineal body reconstruction and vaginoplasty (3), excision of vulval fibrosis and muco cutaneous anastomosis (1), repair of urethrovaginal fistula (1), VVF repair with soft tissue transposition (1). One case of sexual abuse was managed conservatively.

RESULTS: All anastomotic urethroplasties were successful. Continence is preserved even in cases with bladder neck injury and stricture. The girl with urethral substitution has completed two years follow up and is well. She voids to completion and is continent. However, she has a weak bladder sensation. Two patients have stress incontinence (VVF, complex stricture). Uremia subsided in the case of fibrosing vulva. Cosmetic appearance after perineal body repair is good. Upper renal tracts are maintained in all.

CONCLUSIONS: End to end anastomosis through retropubic space is possible in urethral injuries

Continence can be preserved even in bladder neck injuries which otherwise are considered for permanent diversion. They may require urethral substitution, which may be done with Monti ileum segment.

Combined posterior sagittal and transpubic approach is useful in complex cases.

Fibrin glue and demucosalised ileum as soft tissue interposition improve results.

Source of Funding: None