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Background: Injuries to the female urethra associated with pelvic fracture are uncommon. Injuries may be partial or circumferential. When rupture has taken place at the proximal urethra is often total and complete and associated with vaginal laceration. The results of delayed surgical treatment to restore urethral continuity in girls with pelvic-fracture urethral disruptions were retrospectively reviewed. Methods: Between 1984 and 1997, 6 girls 4 to 9 years old (median age 7) with urethral injuries associated with pelvic fracture were treated in our institution. Immediate treatment included suprapubic cystostomy in 2 patients, urethral catheter alignment and simultaneous suprapubic cystostomy in 3, and temporary urethral catherization in 1. Of these 6 patients 4 with proximal urethral distraction defects were treated with delayed 1-stage anastomotic repair, 1 with mid urethral avulsion was managed by construction of a neourethra from the vaginal wall and 1 with a simple contusion did not require surgical treatment. Five patients had concomitant vaginal rupture and were treated at the time of the delayed urethral repair. Surgical approach was abdomino-vaginal in 2 cases and transpubic-vaginal in 3. Associated injuries also included rectal rupture in 3 and bladder neck laceration in 2. Overall postoperative follow-up ranged from 1 to 6 years (median 5). Results: In all patients treated with suprapubic cystostomy alone and simultaneous urethral realignment and cystostomy urethral obliteration developed. The stricture-free rate of 1-stage anastomotic repair and substitution urethroplasty was 100%. One patient developed urinary incontinence while 1 other is only wet during night time. Retrospectively, associated bladder neck injury was related to the initial trauma in 1 of the 2 incontinent girls. Two recurrent vaginal strictures were treated successfully with additional transposition of lateral labial flaps. Conclusions: In our study primary realignment of the urethra did not prevent the development of severe urethral obliteration. This study also emphasizes that the combined transpubic-vaginal access is a reliable approach to reestablish urethral continuity and simultaneously reconstruct associated vaginal rupture or previous bladder neck damage., Miguel L. Podesta, MD, Ricardo Medel, MD, Roberto Castera, MD and Marcela Herrera. Urology Unit, Hospital de Ninos Ricardo Gutierrez, Buenos [...]