title: Traumatic posterior urethral disruptions in boys: experience with the perineal/perineal-transpubic approach in ten cases.
abstract: The management of traumatic posterior urethral disruption in children has ranged from primary realignment/repair to delayed urethroplasty. The operative approach may be perineal or transpubic; the advocates of either cite comparable outcome. The anatomic considerations in a child differ from the adult and the management is individualized. We present our experience with the perineal/perineal-transpubic approach in the management of traumatic posterior urethral disruptions in ten boys. A preliminary suprapubic cystostomy was followed by a delayed urethroplasty after comprehensive investigations to delineate the pathoanatomy of the disruption. The urethroplasty began with a perineal exposure and progressed to varying extents to achieve a satisfactory urethral anastomosis. Four cases of bulbomembranous disruption were repaired by perineal approach, whereas six cases of prostatomembranous disruption required a perineal-transpubic approach. Permutations of operative techniques (circumurethral mobilization, corporeal separation/urethral rerouting, pubectomy and omentoplasty) were used. The follow-up assessed micturition patterns, urinary continence and penile erections. At a mean follow-up of 5 years (1.5-12 years), all ten boys void in a good stream and are continent. All have normal penile erections, posture and gait. The paper discusses the rationale and outcome of our management.
authors.affiliation: Department of Paediatric Surgery, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, 560034 Bangalore, India.
authors.forename: Kanishka
authors.initials: K
authors.lastname: Das
authors.forename: Antony Robert
authors.initials: AR
authors.lastname: Charles
authors.forename: Anand
authors.initials: A
authors.lastname: Alladi
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rao
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: D'Cruz
mesh_terms: D002648:Child; D003559:Cystostomy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010502:Perineum; D013997:Time Factors; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods