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Published on: January 7, 2019
An evaluation of surgical approaches for posterior urethral distraction defects in boys
Jiong Zhang1, Yue-Min Xu, Yong Qiao
1Department of Urology, Sixth People's Hospital, ShangHai Jiao Tong University, ShangHai, People's Republic of China.
Insights
The transperineal-inferior pubic approach offers superior outcomes for complex posterior urethral distraction defects in boys. This method provides better results and fewer complications than other surgical techniques.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Urethral Stricture Disease
Background:
- Complex posterior urethral distraction defects present significant surgical challenges in pediatric patients.
- Previous operative approaches have varying success rates and complication profiles.
Purpose of the Study:
- To evaluate the preliminary experience with different operative approaches for complex posterior urethral distraction defects in children.
- To compare the efficacy and safety of perineal, transperineal-inferior pubic, and transpubic-perineal approaches.
Main Methods:
- A cohort of 24 boys (ages 7-14) with obliterative complex posterior urethral distraction defects were treated between 1998 and 2002.
- Three surgical techniques were employed: perineal approach (5 patients), transperineal-inferior pubic approach (10 patients), and transpubic-perineal approach (9 patients).
- Patients were followed for 1-5 years postoperatively to assess outcomes and complications.
Main Results:
- An overall success rate of 79.2% (19/24) was achieved, with no stricture recurrence.
- The transperineal-inferior pubic approach demonstrated the highest success rate at 90% (9/10).
- Complications included fistulas and gait abnormalities, with the transpubic-perineal approach associated with postoperative gait issues.
Conclusions:
- The transperineal-inferior pubic approach provides excellent exposure without compromising pelvic stability.
- This approach yields superior results compared to perineal and transpubic-perineal methods for complex posterior urethral distraction defects.
- The transperineal-inferior pubic approach is recommended as the primary operative treatment for these defects in boys.
Purpose:
We present our preliminary experience with operative approaches in the treatment of complex posterior urethral distraction defects in children.
Materials And Methods:
A total of 24 boys 7 to 14 years old with obliterative complex posterior urethral distraction defects were treated with 1 of 3 surgical approaches between January 1998 and December 2002. A perineal approach was used in 5 cases, a transperineal-inferior pubic approach including distal urethral mobilization, corporeal body separation and inferior pubectomy in 10, and a combined transpubic-perineal approach in 9.
Results:
Patients were followed 1 to 5 years postoperatively. A successful result of no recurrence of stricture was achieved in 19 of 24 patients (79.2%), including 3 of 5 (60%) treated with a perineal approach, 9 of 10 (90%) with a transperineal-inferior pubic approach and 7 of 9 (77.8%) with a transpubic-perineal approach. Complications included 1 combined false passage, which was resolved using a transperineal-inferior pubic approach, 2 urethrocutaneous fistulas, which were resolved using a perineal approach in 1 and a transpubic-perineal approach in 1, and 3 rectourethral fistulas, which were resolved using a transpubic-perineal approach in 1 and a transperineal-inferior pubic approach in 1. Of the 9 patients treated with the transpubic-perineal approach 3 walked with an abnormal gait postoperatively.
Conclusions:
The transperineal-inferior pubic approach fully exposes the space behind the pubis, does not damage pelvic stability and yields better results compared to the perineal and transpubic-perineal approaches. We recommend it as first line operative treatment for complex posterior urethral distraction defects in boys.
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