Traumatic strictures of the posterior urethra in boys with special reference to recurrent strictures

Area of Science:

• Pediatric Urology
• Trauma Surgery
• Reconstructive Urology

Background:

• Traumatic urethral strictures in boys, often resulting from pelvic fractures, present significant reconstructive challenges.
• Recurrent strictures after initial repair necessitate specialized surgical approaches.

Purpose of the Study:

• To analyze 18 years of surgical experience with traumatic urethral strictures in pediatric patients.
• To evaluate the outcomes of primary and re-do urethroplasty, with a focus on recurrent strictures.

Main Methods:

• A cohort of 34 boys with pelvic fracture urethral strictures underwent 35 repairs over 18 years.
• Surgical techniques included anastomotic urethroplasty and substitution urethroplasty.
• Patients were divided into primary (no prior urethral repair) and re-do (previous failed attempts) groups, with median follow-up of 9 and 8 years, respectively.

Main Results:

• Primary urethroplasty achieved a success rate of 22/23 (over 95%), with minimal impact on erectile function and upper tracts.
• In the re-do group, anastomotic urethroplasty succeeded in 5/12 (41%), while substitution urethroplasty was required for 7 patients with complex strictures, yielding acceptable results.
• Two patients in each group developed stress incontinence; upper tracts were maintained in all patients.

Conclusions:

• Anastomotic urethroplasty is the preferred and highly successful method for primary traumatic urethral strictures in boys.
• Substitution urethroplasty provides a viable and acceptable alternative for complex or recurrent urethral strictures, preserving urinary and sexual function.
• Long-term follow-up confirms the durability of reconstructive techniques for pediatric urethral strictures.