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Traumatic bladder neck lacerations extending into the urethra are devastating injuries that occur more commonly in children than in adults. It is unclear whether immediate repair of these injuries decreases long-term complications, such as urinary incontinence. We report our long-term results with immediate operative repair of these injuries.

Materials and Methods:

Since 1986, we have primarily repaired all individuals sustaining traumatic longitudinal bladder neck lacerations extending into the urethra within 24 hours of injury. All patients were followed a minimum of 2 years.


A total of 12 patients 2 to 16 years old sustained longitudinal bladder neck lacerations extending into the proximal urethra. Median followup was 7 years (range 2 to 13). Postoperatively none of the 12 patients recovered complete urinary continence. Periurethral bulking agents were attempted in all 12 patients with no long-term improvement. Eight patients (75%) pursued additional surgery. Three boys underwent artificial urinary sphincter placement, of which all subsequently eroded. Three girls underwent bladder neck reconstruction with fascial sling procedures, of whom 2 became continent but experienced urinary retention, while 1 became partially continent. Five patients, including the 3 boys with artificial urinary sphincter erosion, ultimately underwent bladder neck closure and continent diversion.


Traumatic longitudinal bladder neck and proximal urethral lacerations are devastating injuries fraught with long-term complications and the need for additional surgery despite immediate surgical repair. Bladder neck closure and continent diversion should be considered in girls with substantial traumatic urethral loss and in boys with persistent urinary incontinence following primary repair.


  • 1 : Prostatomembranous urethral disruptions: management by suprapubic cystostomy and delayed urethroplasty. J Urol1990; 144: 76. LinkGoogle Scholar
  • 2 : Urethral and bladder neck injury associated with pelvic fracture in 25 female patients. J Urol2006; 175: 2140. LinkGoogle Scholar
  • 3 : Urethral injuries in female subjects following pelvic fractures. J Urol1992; 147: 139. LinkGoogle Scholar
  • 4 : Traumatic rupture of the female urethra. J Urol1979; 122: 560. LinkGoogle Scholar
  • 5 : Trauma to the bladder neck, trigone and vagina in children. J Urol1984; 131: 747. LinkGoogle Scholar
  • 6 : Genitourinary tract injuries in girls. Br J Urol1996; 78: 446. Google Scholar
  • 7 : Genitourinary tract injuries due to fracture of the pelvis in females: sequelae and their management. Br J Urol1982; 54: 32. Google Scholar
  • 8 : Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases. J Urol1998; 159: 1206. LinkGoogle Scholar
  • 9 : 10-Year experience with artificial urinary sphincter in children and adolescents. J Urol2001; 165: 2373. LinkGoogle Scholar
  • 10 : A single-centre long-term outcome analysis of artificial urinary sphincter placement in children. BJU Int2002; 89: 82. Google Scholar
  • 11 : Experience with non-cycled artificial urinary sphincters. BJU Int2004; 93: 1049. Google Scholar
  • 12 : The outcome of artificial urinary sphincter placement after a mean 15-year follow-up in a paediatric population. BJU Int1999; 83: 1026. Google Scholar

Department of Urology, Mayo Clinic, Rochester, Minnesota