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Posttraumatic posterior urethral strictures in children: a 20-year experience
1Department of Urology, Faculty of Medicine, University of Alexandria, Egypt.
Insights
Pediatric urethral strictures after pelvic fractures often occur with specific fracture types. Bulboprostatic anastomosis via perineal or transpubic approaches offers the best outcomes for these challenging injuries.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Reconstructive Urology
Background:
- Pelvic fractures in children can lead to urethral injuries and subsequent strictures.
- Understanding the characteristics of these strictures is crucial for effective management.
Purpose of the Study:
- To identify specific features of urethral strictures resulting from pelvic fractures in pediatric patients.
- To evaluate the success rates of different surgical techniques for treating these strictures.
Main Methods:
- A retrospective review of 68 boys (ages 3-15) with pelvic fracture urethral disruption.
- Analysis of 78 urethroplasties, including perineal bulboprostatic anastomosis, transpubic bulboprostatic anastomosis, and two-stage urethroscrotal inlay.
Main Results:
- Perineal and transpubic bulboprostatic anastomosis achieved success rates of 93% and 91%, respectively.
- The two-stage urethroscrotal inlay technique had a failure rate of 54%.
Conclusions:
- Malgaigne's fracture and straddle fractures are commonly associated with pediatric urethral strictures.
- Perineal or transpubic bulboprostatic anastomosis is the preferred treatment, while internal urethrotomy should be avoided.
- Management of associated bladder neck incompetence can be deferred post-urethroplasty.
Purpose:
We attempted to identify the particular features of strictures complicating pelvic fracture urethral injuries in children.
Materials And Methods:
A total of 68 boys 3 to 15 years old who had sustained pelvic fracture urethral disruption underwent 78 urethroplasties performed by bulboprostatic anastomosis through the perineum in 42, transpubically in 23 and by 2-stage urethroscrotal inlay in 13.
Results:
Perineal and transurethral urethroplasty was successful in 93 and 91% of cases respectively. There was a 54% failure rate after urethroscrotal inlay.
Conclusions:
Urethral strictures were most commonly associated with Malgaigne's fracture (35% of cases) and straddle fracture with or without diastasis of the sacroiliac joint (26%). Strictures were almost invariably inferior to the verumontanum with prostatic displacement in 44% of cases. Length of the strictured segment may be overestimated or underestimated on urethrography as a result of incomplete filling of the prostatic urethra or a urinoma cavity connected with the proximal segment, respectively. Perineal or transpubic bulboprostatic anastomosis is the best treatment for posttraumatic strictures, while internal urethrotomy should be avoided since it may compromise the chance of subsequent anastomotic urethroplasty. Repair of associated bladder neck incompetence may be deferred until the resumption of urethral voiding after urethroplasty, when incontinence can be documented.
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