Our experience with progressive perineal urethroplasty and anastomotic urethroplasty in post-traumatic urethral strictures in pediatric patients

Abstract

Background: Confined perineum and elevated prostate and bladder in children make management of post-traumatic stricture in children technically difficult.Methods: A retrospective study of patients from 2007 till September 2016 was conducted. 15 pediatric patients with a mean age of 7.3 years presented with post traumatic urethral stricture or distraction defect. 11 patients had pelvic fracture urethral distraction defect (PFUDD) and underwent PPU. Four had bulbar stricture caused by straddle injury and underwent EEU. Post operatively patients were evaluated using uroflowmetry at 3, 6 and 12 months. Maximum velocity of less than 10 ml/s and symptoms of straining was considered as recurrence and such cases were evaluated further with MCU, RGU and cystoscopy.Results: Mean stricture length was of 2.3 cm and was at bulbo-membranous junction in 11 and in proximal bulbar urethra in 4. Of the 11 PPUs, crural separation was done in nine and inferior pubectomy in six patients. Transpubic approach was required in one patient. Gracilis flap was placed in one patient as an onlay over anastomotic urethroplasty. Of the 11 PPUs, 2 patients and 1 of 4 EEU patients had recurrence. All recurrent strictures were <1.5 cm long and at the site of the anastomosis. Two patients were managed with anastomotic urethroplasty. The remaining one patient could be managed with laser visual internal urethrotomy.Conclusions: PPU and EEU are treatment of choice in paediatric patients with PFUDD and proximal bulbar strictures respectively. Both are technically feasible, have good outcome and have an acceptable morbidity.