Amit Singh1, Shasanka Shekhar Panda2, Minu Bajpai3, Manisha Jana4, Dalim Kumar Baidya5. 1. Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India. Electronic address: amitps2011@gmail.com. 2. Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India. Electronic address: drshasank_aiims@yahoo.co.in. 3. Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India. Electronic address: http://www.paediatric-urologyonline.com. 4. Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India. Electronic address: manishajana@gmail.com. 5. Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India. Electronic address: dalimkumarb001@yahoo.co.in.
Abstract
PURPOSE: To share our experience, technique and long-term outcomes in posterior urethral stricture management. MATERIALS AND METHODS: Thirty-seven boys with post-traumatic posterior urethral stricture underwent resection and end-to-end anastomosis through pre-anal coronal approach or in combination with trans-pubic approach from January 2000 to December 2011. Follow up included symptomatic evaluation by micturating cystourethrogram and retrograde urethrogram in all patients, and urethroscopy in patients with voiding symptoms. RESULTS: Pre-anal coronal approach was used in 29 (78%) cases and in 8 (21%) cases it was combined with trans-pubic approach. In 33 (89.1%) patients it was first attempt, while in 4 (10.9%) it was redo surgery. Two patients required buccal mucosal graft to bridge the deficient urethra. Patient age was 5-17 years (mean 10.8 years). Mean follow up was 48.5 months (range 6-132 months). Thirty-two (86%) patients were symptom free. Failed repairs were successfully managed by urethral dilation in 3 and by redo urethroplasty in the remaining 2. All patients were continent. There was no chordee, penile shortening or urethral diverticula. CONCLUSIONS: Resection and end-to-end anastomosis of posterior urethral stricture is possible through pre-anal coronal incision; however, if slightest difficulty is envisaged in creating a satisfactory end-to-end anastomosis, extension to trans-pubic approach should be done.
PURPOSE: To share our experience, technique and long-term outcomes in posterior urethral stricture management. MATERIALS AND METHODS: Thirty-seven boys with post-traumatic posterior urethral stricture underwent resection and end-to-end anastomosis through pre-anal coronal approach or in combination with trans-pubic approach from January 2000 to December 2011. Follow up included symptomatic evaluation by micturating cystourethrogram and retrograde urethrogram in all patients, and urethroscopy in patients with voiding symptoms. RESULTS: Pre-anal coronal approach was used in 29 (78%) cases and in 8 (21%) cases it was combined with trans-pubic approach. In 33 (89.1%) patients it was first attempt, while in 4 (10.9%) it was redo surgery. Two patients required buccal mucosal graft to bridge the deficient urethra. Patient age was 5-17 years (mean 10.8 years). Mean follow up was 48.5 months (range 6-132 months). Thirty-two (86%) patients were symptom free. Failed repairs were successfully managed by urethral dilation in 3 and by redo urethroplasty in the remaining 2. All patients were continent. There was no chordee, penile shortening or urethral diverticula. CONCLUSIONS: Resection and end-to-end anastomosis of posterior urethral stricture is possible through pre-anal coronal incision; however, if slightest difficulty is envisaged in creating a satisfactory end-to-end anastomosis, extension to trans-pubic approach should be done.