Posttraumatic posterior urethral strictures in children--management and intermediate-term follow-up in tertiary care center.
OBJECTIVE
To evaluate the management and intermediate-term follow-up of posttraumatic posterior urethral strictures in children.


METHODS
From March 2000 to November 2006, the surgical records of 28 children (< or = 18 years) who had been admitted for treatment of posttraumatic posterior urethral strictures were retrospectively reviewed. The patients had been followed up for a median of 36 months (range 3-58). The cause of trauma, extent of urinary tract injury, radiologic examination findings, previous treatment, and its effect on the final outcome, treatment complications,, and failures were evaluated.


RESULTS
The mean age of the patients was 12.1 years (range 5-18) at the injury. The estimated radiographic mean stricture length before surgery was 3.41 cm (range 2-6). Of the 28 patients, 27 were treated with transperineal anastomotic urethroplasty, with a success rate of 75%. All treatment failures were at the anastomotic site and occurred within the first year of anastomotic urethroplasty. The failed repairs (7 cases) were successfully managed endoscopically in 4 patients and by redo urethroplasty in 3, for a final success rate of 100%. Of the 28 patients, 15 (80%) with urethral manipulation before anastomotic urethroplasty had a satisfactory result compared with 69.3% of patients without previous surgical treatment. The difference was not statistically significant.


CONCLUSIONS
Most posttraumatic posterior urethral strictures in children can be managed through the perineal route. The transpubic approach should be reserved for more complex posterior strictures. Previous urethral manipulations did not affect the intermediate-term results of anastomotic urethroplasty.
Singla
Manish
M
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
Jha
Mrigank S
MS
Muruganandam
K
K
Srivastava
Aneesh
A
Ansari
Mohd S
MS
Mandhani
Anil
A
Dubey
Deepak
D
Kapoor
Rakesh
R
D000293:Adolescent; D002648:Child; D004724:Endoscopy / Q000379:methods; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014525:Urethral Stricture / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014572:Urology / Q000379:methods*; D014947:Wounds and Injuries