Transpubic Posterior Urethroplasty via Perineal Approach in Children : A New Technique

Abstract

PURPOSE Is to evaluate a new the technique of transpubic urethroplasty via perineal approach for managment of pelvic fracture urethral distraction defect (PFUDD) in children. MATERIAL AND METHODS A prospective study was performed on 52 children undergoing posterior urethroplasty for pelvic fracture urethral distraction defect. After perineal midline approach and excision of all fibrous tissues , 6 out of 52 children had a short urethra that could not bridge the gap (more than 5 cm) to do tension free anastomosis . For the latter group ,transpubic posterior urethroplasty via perineal approach was performed. Firstly, the upper border of the symphysis pubis was palpated and the corporal separation was done distally till this level (peno-scrotal junction). Dissection of one crus started from Medial to lateral edge. After complete separation from the bone, the same was done for the other crus. Two crura was hold laterally with tape and two longitudinal lines were performed over the pubic bone, the distance in between about 4 cm. By cutting diathermy over theses lines, separation of the pubic bone from lateral attachment was performed. The separated bone was hold by nipple forceps and complete separation from the bladder was done by cutting diathermy. Easy bulbo-prostatic anastomosis was performed. RESULTS All six children had a good urinary stream without any post-operative complication related to the technique. CONCLUSIONS Transpubic urethroplasty via perineal approach in children is a feasible easy technique with very minimal morbidity and can be done safely in children when indicated. Easy Bulbo-prostatic anastomosis can be done through the perineal exposure.