Posttraumatic Posterior Urethral Strictures in Children: A 20-Year Experience

Abstract

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.

Transpubic Urethroplasty for Complex Posterior Urethral Strictures: A Single Center Experience

“…These include: (1) stricture length of 1 3 cm; (2) associated perineal or rectourethral fistulas, peri- urethral cavities, osteomyelitis, false passages; (3) incompetent bladder neck, and (4) previous failed repairs [1] . The association of one or all of these complicating features along with restricted surgical access makes subsequent urethral reconstruction very challenging [2] . Most of the posterior urethral injuries are simple for whatever perineal approach is favored.…”

“…We had 7 children and 12 adults. Children more often develop complex strictures following trauma in comparison to adults because of the rudimentary prostate and underdeveloped puboprostatic ligaments [2,14] . We found the procedure to be easy in children who have pliable bone in comparison to adults.…”

Diagnosis and Management of Pediatric Urethral Injuries

“…In contrast to adults, the intra-abdominal location of the bladder and the prepubescent smaller as well as more cranially placed prostate predispose to complete posterior urethral rupture in boys [3] (fig. 1).…”

“…Because of the more abdominally located bladder and small prostate in boys, urethral injury frequently comprises both the membranous and supraprostatic regions [28]. However, it is controversial whether injuries of the mid-prostatic urethra ever result in transverse cuts or strictures rather than anterior longitudinal tears without stricture formations [3]. Mainly because of the incomplete filling of the prostatic urethra, the accurate distance of the distraction defect is frequently misjudged; therefore, a priori transpubic urethroplasty is often preferred [3].…”

“…However, it is controversial whether injuries of the mid-prostatic urethra ever result in transverse cuts or strictures rather than anterior longitudinal tears without stricture formations [3]. Mainly because of the incomplete filling of the prostatic urethra, the accurate distance of the distraction defect is frequently misjudged; therefore, a priori transpubic urethroplasty is often preferred [3]. MRI can resolve this problem not only because the required general anesthesia in infants results in ideal examination conditions, but also because MRI provides anatomic detail of the periurethral tissues and the orientation of the lesion in three dimensions [29].…”