title: Traumatic strictures of the posterior urethra in boys with special reference to recurrent strictures.
abstract: OBJECTIVE
  We report 18 years' experience of traumatic urethral strictures in boys with emphasis on recurrent strictures.
  
  
  METHODS
  Thirty-four boys with pelvic fracture urethral strictures underwent 35 repairs: 23 in the primary group (initial suprapubic cystostomy, but no urethral repair) and 12 in the re-do group (previously failed attempt(s) at urethroplasty elsewhere). The median age at operation and stricture length was 8.4 years and 3 cm in the primary and 9 years and 5.4 cm in the re-do group, respectively. Anastomotic urethroplasty was performed wherever possible, or failing this a substitution urethroplasty. Median follow up was 9 years for primary group and 8 years for re-do group.
  
  
  RESULTS
  Primary group: urethroplasty was successful in 22/23, with 10 by perineal and 13 by additional transpubic approach. Two have stress incontinence. Erectile function is unchanged in all and upper tracts are maintained. One had recurrent stricture. Re-do group (12 including 1 recurrence from primary group): anastomotic urethroplasty was done in 5 and substitution urethroplasty in 7. Patients needing substitution had long stricture (>5 cm), stricture extending to distal bulb, or high riding bladder neck. All patients are voiding urethrally. Two patients with substitution required dilatation for early re-stenosis. One appendix substitution required delayed revision. Two have stress incontinence. Erectile function was unaffected. Upper tracts are maintained.
  
  
  CONCLUSIONS
  Anastomotic urethroplasty was successful in over 95% of primary cases. In re-do cases it was viable in only 41% of cases; the rest required substitution urethroplasty. Urethral substitution also gave acceptable results.
authors.affiliation: Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India. satish.childurology@gmail.com
authors.forename: Satish Kumar
authors.initials: SK
authors.lastname: Aggarwal
authors.forename: Shandip K
authors.initials: SK
authors.lastname: Sinha
authors.forename: Arun
authors.initials: A
authors.lastname: Kumar
authors.forename: Nitin
authors.initials: N
authors.lastname: Pant
authors.forename: Nitin Kumar
authors.initials: NK
authors.lastname: Borkar
authors.forename: Anjan
authors.initials: A
authors.lastname: Dhua
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005355:Fibrosis; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008297:Male; D010384:Pelvic Bones / Q000293:injuries*; D012008:Recurrence; D012086:Reoperation; D014521:Urethra / Q000293:injuries* / Q000473:pathology; D014525:Urethral Stricture / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*