title: An evaluation of surgical approaches for posterior urethral distraction defects in boys.
abstract: OBJECTIVE
  We present our preliminary experience with operative approaches in the treatment of complex posterior urethral distraction defects in children.
  
  
  METHODS
  A total of 24 boys 7 to 14 years old with obliterative complex posterior urethral distraction defects were treated with 1 of 3 surgical approaches between January 1998 and December 2002. A perineal approach was used in 5 cases, a transperineal-inferior pubic approach including distal urethral mobilization, corporeal body separation and inferior pubectomy in 10, and a combined transpubic-perineal approach in 9.
  
  
  RESULTS
  Patients were followed 1 to 5 years postoperatively. A successful result of no recurrence of stricture was achieved in 19 of 24 patients (79.2%), including 3 of 5 (60%) treated with a perineal approach, 9 of 10 (90%) with a transperineal-inferior pubic approach and 7 of 9 (77.8%) with a transpubic-perineal approach. Complications included 1 combined false passage, which was resolved using a transperineal-inferior pubic approach, 2 urethrocutaneous fistulas, which were resolved using a perineal approach in 1 and a transpubic-perineal approach in 1, and 3 rectourethral fistulas, which were resolved using a transpubic-perineal approach in 1 and a transperineal-inferior pubic approach in 1. Of the 9 patients treated with the transpubic-perineal approach 3 walked with an abnormal gait postoperatively.
  
  
  CONCLUSIONS
  The transperineal-inferior pubic approach fully exposes the space behind the pubis, does not damage pelvic stability and yields better results compared to the perineal and transpubic-perineal approaches. We recommend it as first line operative treatment for complex posterior urethral distraction defects in boys.
authors.affiliation: Department of Urology, Sixth People's Hospital, ShangHai Jiao Tong University, ShangHai, People's Republic of China.
authors.forename: Jiong
authors.initials: J
authors.lastname: Zhang
authors.forename: Yue-Min
authors.initials: YM
authors.lastname: Xu
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiao
authors.forename: San-Bao
authors.initials: SB
authors.lastname: Jin
authors.forename: Deng-Long
authors.initials: DL
authors.lastname: Wu
authors.forename: Bao-Jun
authors.initials: BJ
authors.lastname: Gu
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D014521:Urethra / Q000293:injuries / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*