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Transpubic posterior urethroplasty via perineal approach in children: a new technique
1Urology Department, Alexandria College of Medicine, Alexandria, Egypt. sshorabi004@hotmail.com
Insights
Transpubic urethroplasty via perineal approach is a feasible technique for managing complex pediatric urethral defects. This method offers advantages for children with short urethras, achieving good urinary flow post-surgery.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Urethral Stricture Disease
Background:
- Pelvic fracture urethral distraction defects (PFUDD) pose surgical challenges in children.
- A significant subset of PFUDD cases involves urethral gaps too large for standard posterior urethroplasty.
- Novel surgical approaches are needed for complex pediatric PFUDD.
Purpose of the Study:
- To evaluate a novel transpubic urethroplasty via perineal approach for pediatric PFUDD.
- To assess the feasibility and outcomes of this technique in children with short urethras.
Main Methods:
- A transpubic posterior urethroplasty via perineal approach was performed in 12 children with PFUDD and urethral gaps >5 cm.
- Patients aged 5.2-12 years underwent the procedure.
- Follow-up included clinical assessment, radiological studies, and uroflowmetry for up to 5 years.
Main Results:
- The mean follow-up was 2.7 years.
- All 12 children achieved a good urinary stream.
- 25% experienced transient stress urinary incontinence, and 75% had a short penis postoperatively.
Conclusions:
- Transpubic urethroplasty via perineal approach is a viable and advantageous technique for complex pediatric PFUDD.
- This method effectively manages challenging urethral defects in children.
Objective:
To evaluate a new technique of transpubic urethroplasty via perineal approach for management of pelvic fracture urethral distraction defects (PFUDD) in children.
Methods:
Of 78 children undergoing posterior urethroplasty for PFUDD, 12 (15.4%) had a short urethra that could not bridge the gap (>5 cm) for a tension-free anastomosis. Age ranged from 5.2 to 12 years (median = 8.5 years). The median distraction defect length was 4.8 cm (range 3.7-6.4 cm). For the latter group, the new technique of transpubic posterior urethroplasty via perineal approach was performed. The first follow-up visit was scheduled 1 month after suprapubic catheter removal. Radiological studies and uroflowmetry were repeated at 6-month intervals for 1 year and once yearly thereafter.
Results:
Patients were followed up for a period of 6 months to 5 years with a mean of 2.7 years. Mean operative time was 2.5 h (range 1.9-3.2 h) with a mean blood loss of 200 ml (range 50-640 cc) and the mean hospital stay was 4 days. All 12 children had a good urinary stream over the follow-up period; 3/12 (25%) developed stress urinary incontinence that resolved within 6 months postoperatively; 9/12 (75%) complained of (retracted) short penis.
Conclusions:
Transpubic urethroplasty via perineal approach is a feasible technique for management of complex PFUDD in children, and presents many advantages over other routes.
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