Urethral sphincter botulinum-A toxin injection could be considered a reliable treatment modality in children with nonneurogenic neurogenic bladder after the failure of conservative therapy.

Bulboprostatic anastomotic urethroplasty was performed in 20 children with posterior urethral strictures secondary to bony pelvic fractures. The approach was perineal in 4 children and transpubic abdominoperineal in 16, with good postoperative results in 100 and 62.5%, respectively. In some children the urethral disruption occurred within the prostate itself and not at the prostatomembranous junction. In such cases the proximal sphincteric mechanism may be at risk and immediate repair of the injury is advisable. In the case of common prostatomembranous disruption displacement of the urethra may be significant. In such cases a transpubic approach is preferable. If the proximal sphincteric mechanism is deranged, it can be managed at the same time.

Urethral pressure profiles (in vivo), opening pressures, and flow rates at opening pressure (in vitro) were determined for female, male, pregnant, ovariectomized (OVX), OVX and then estrogen-treated, and OVX and then progesterone-treated rabbits. Using the isolated whole-urethra preparation, we determined the opening pressures and flow rates as well as the effects of 250 microM phenylephrine, 250 microM bethanechol, and 120 mM KCl on the urethral opening pressure and flow rate. The results demonstrated that (1) the urethral pressure profiles were similar for male and female rabbits, (2) ovariectomy and pregnancy decreased the urethral pressure profiles, (3) estrogen therapy partially reversed the effect of ovariectomy on the urethra, and (4) progesterone therapy had little effect on the urethral pressure profile. With regard to opening pressure and flow, (1) flow at opening pressure was lower in the male than in the female; (2) the opening pressure was increased by ovariectomy; (3) phenylephrine and KCl stimulated a greater response in the male than in the female, whereas the response to bethanechol was significantly lower in the male than in the female; (4) the male had the greatest resistance to flow among all the groups; and (5) ovariectomy increased the resistance to flow and estrogen treatment reversed the effect of ovariectomy. In conclusion, ovariectomy had significant effects on urethral function that were reversed by estrogen therapy but not by progesterone therapy.

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