PURPOSE: To summarize our treatment experience of acute urethral trauma in pre-pubertal girls. METHODS: We retrospectively analyzed six pre-pubertal girls with acute severe urethral trauma who were admitted to our hospital from April 2003 to April 2023 and followed up. RESULTS: All six patients had pelvic fractures and vaginal injuries, and one had a rectal injury. Five showed a large amount of fresh blood flowing from the perineum and an inability to urinate. However, the remaining patient had a more insidious onset, causing the emergency doctors to miss the diagnosis. Four had severe perineal tearing and had lost their normal urethral and vaginal openings, making urinary catheter insertion impossible. The diagnosis was very clear. The other two were diagnosed with urethrovaginal injury during cystourethroscopy. Five underwent urethral and vaginal repair surgery within 7 days after the injury, and two of them developed complications requiring endoscopy or reoperation. Postoperative questionnaire scoring showed that four patients had normal urinary function and two had mild dysfunction. CONCLUSION: The diagnosis of acute urethral injury in girls needs doctors' attention. If the patient's vital signs are stable, urgency urethrovaginal repair surgery can be performed. Although this is difficult and requires experienced pediatric urologists, it facilitates discovery of concurrent injuries.