Noniatrogenic Urethral Trauma in Children: A Narrative Review.

Background and objective: Pediatric urethral trauma is rare, and treatment recommendations are often extrapolated from evidence for adults. We conducted a systematic review of the literature to evaluate management strategies, outcomes, and the quality of reporting for pediatric urethral trauma. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 31 relevant studies published since 1990. Studies were eligible for inclusions if they reported results for five or more patients with at least 3 mo of follow-up for noniatrogenic urethral trauma. Methodological quality was assessed using the Methodological Index for Nonrandomized Studies (MINORS) tool. Key findings and limitations: The quality of evidence was low: most studies were retrospective single-center cohorts and there was inconsistent reporting of management and outcomes. Open reconstruction was reported more frequently than endoscopic management. Across treatment modalities, the overall stricture rate was ∼20%. Continence and sexual function outcomes were generally favorable. However, data on repeat surgery and quality of life were insufficient for firm conclusions. Conclusions and clinical implications: The most striking finding from our review is the poor quality and inconsistency of the literature on pediatric urethral trauma. As well as summarizing the outcome data available, we provide a table of recommendations for improving future studies, including the use of standardized definitions, validated pediatric patient-reported outcome measures, and consistent long-term follow-up. Patient summary: We looked at the evidence on treatments and outcomes after accidental damage to the urethra in children. No definitive conclusions can be drawn because the quality of the research is low and inconsistent. We provide advice for future research.