Introduction and Objective
PFUDD injuries in females are exceedingly rare, particularly in paediatric patients. Managing these injuries presents significant challenges due to the unique anatomical constraints of the female urethra, limited paediatric data, and the high risk of postoperative complications such as urethrovaginal fistula formation. This case series highlights the mechanism of injury, surgical management with postoperative outcomes and challenges faced in managing two young female patients having PFUDD following high-energy trauma.

Study Design : Observational description of rare case series

Two paediatric female patients with PFUDD secondary to road traffic accidents (RTA) were managed at our institution.
Case 1: A 12-year-old girl sustained multiple pelvic fractures and complete urethrovaginal transection following a bus accident. Initial stabilisation included suprapubic cystostomy (SPC) and orthopaedic fixation. Examination under anaesthesia revealed a 1.5 cm urethral defect with both transected ends opening into the vagina. Definitive reconstruction was performed using a combined abdominoperineal approach with bilateral anterior osteotomy, urethrovaginal fistula excision, primary urethral anastomosis, and a Martius flap.

Case 2: An 8-year-old girl sustained urethral trauma after being run over by a tractor and had been on SPC since May 2024. Upon referral, antegrade and retrograde scopy revealed a 3 cm urethral segment ending in the anterior vaginal wall with complete bladder neck fibrosis. She underwent excision of the stricturous segment and a modified Tanagho repair with autologous rectus neourethral sling reconstruction.

Case 1: Currently under follow up, the patient is off catheter, continent, and dry for most of the day. However, a small urethrovaginal fistula persists, leading to pooling of urine in the vagina during voiding.

Case 2 : Postoperatively, she was discharged with SPC and per-urethral catheter (PUC) in situ. However, she later developed continuous dribbling of urine per urethra post catheter removal. Cystoscopy confirmed a neourethrovaginal fistula, necessitating ongoing catheter management and further evaluation for secondary intervention.

Despite technically successful reconstructions, both patients developed postoperative urethrovaginal fistulas. The first patient is voiding well but has a small urethrovaginal fistula, leading to urine pooling in the vagina during voiding. The second patient developed a neourethrovaginal fistula, emphasising the complex nature of PFUDD reconstruction and the risks of postoperative complications.

PFUDD in young females remains a significant reconstructive challenge requiring meticulous surgical planning, multidisciplinary collaboration, and extended surveillance. While advanced reconstructive techniques improve anatomical restoration, postoperative complications such as fistula formation remain a major concern. The first case highlights that even with good voiding, persistent small fistulas can affect quality of life, whereas the second case underscores the importance of long-term follow-up in managing recurrent fistulas. Structured postoperative counselling and close surveillance should be emphasised as an integral component of PFUDD management in paediatric patients. Further research is warranted to refine surgical techniques and postoperative protocols to enhance long-term functional outcomes in this challenging patient population.