Posttraumatic posterior urethral strictures in children: a 20-year experience

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.