Symphysiotomy: a viable approach for delayed management of posterior urethral injuries in children.
OBJECTIVE
The outcome of symphysiotomy for accessing pelvic fracture related, obliterative urethral strictures is described.


METHODS
In 7 boys and 3 girls 4 to 13 years old (mean age 6) surgical correction of a pelvic fracture related, obliterative urethral stricture was achieved through symphysiotomy. The stricture involved a prostatomembranous location in boys and complete vesicourethral distraction in girls. Patients were followed an average of 2.5 years (range 6 months to 4 years) by physical examination, urethrography and endoscopy.


RESULTS
The stricture was successfully corrected in all patients and all void with a normal flow. All boys are continent but 2 of the 3 girls had early incontinence, which resolved with time in 1. In 2 of the 10 cases a previous attempt at perineal repair had already failed. No patient required urethrotomy or dilation and none had significant hemorrhage, fistulization, bladder hernia, chronic pain or secondary gait disturbance.


CONCLUSIONS
Symphysiotomy is hereby revisited as a simple and effective approach for repairing traumatic posterior urethral injuries in the pediatric population. It can be performed instead of transpubic urethroplasty to manage long or otherwise complicated strictures.
Basiri
Abbas
A
Urology Nephrology Research Center, Shahid Beheshti University of Medical Sciences and Iran University of Medical Sciences, Tehran.
Shadpour
Pejman
P
Moradi
Mahmood Reza
MR
Ahmadinia
Hossein
H
Madaen
Kazem
K
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011630:Pubic Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D012189:Retrospective Studies; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D014525:Urethral Stricture / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography