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Outcome of pull-in procedure in children with severe post-disruption posterior urethral strictures
D Erol1, L Emir, C Germiyanoğlu
1Department of Urology, Ankara Research and Training Hospital, Ministry of Health, Turkey.
Insights
This study evaluated a pull-in procedure for posttraumatic posterior urethral strictures in 17 children. The technique, combined with re-catheterization, achieved a 70% success rate in treating urethral strictures.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Urethral Reconstruction
Background:
- Posttraumatic posterior urethral stricture is a challenging condition in children.
- Previous surgical interventions may have limited success rates.
Purpose of the Study:
- To evaluate the efficacy of a pull-in surgical procedure for posttraumatic posterior urethral strictures in pediatric patients.
- To assess the long-term outcomes and identify factors influencing success.
Main Methods:
- A retrospective analysis of 17 children (aged 5-15 years) who underwent a pull-in procedure for posterior urethral strictures over 9 years.
- Diagnostic cystoscopy for synchronous inspection of anterior and posterior urethra.
- Postoperative management including re-catheterization and short-term catheterization for voiding difficulties.
Main Results:
- The pull-in procedure achieved a 70% success rate when combined with postoperative re-catheterization.
- A pedunculated scrotal skin tube successfully treated 2 patients with recurrent strictures.
- Short-term catheterization effectively managed post-stent voiding difficulties.
- Mild chordee was noted in one patient; puberty-related sexual function was preserved in those who reached it.
Conclusions:
- The pull-in procedure is a viable surgical option for pediatric posttraumatic posterior urethral strictures.
- Postoperative management, including re-catheterization, is crucial for optimal outcomes.
- Alternative techniques like scrotal skin tubes can be effective for complex or recurrent cases.
Abstract:
A total of 17 children aged 5 to 15 years with the diagnosis of posttraumatic posterior urethral stricture were operated upon using a pull-in procedure during the last 9 years. Among the diagnostic tools, synchronous inspection of both the anterior and posterior urethra by cystoscopy yielded the most valuable information. A success rate of 70% was achieved with the procedure plus postoperative re-catheterization. A pedunculated tube prepared from the scrotal skin cured 2 patients after a series of failed operations. Difficult voiding occurring after removal of the stent due to an inappropriate pressure gradient created between the bladder neck and urethra usually benefits from short-term catheterization. Mild chordee was present in 1 patient. Ejaculation and erection were present in 3 children who reached puberty.