Pediatric Surgery International

, Volume 11, Issue 5–6, pp 351–353 | Cite as

The transpuboperineal approach for repair of traumatic strictures of the posterior urethra in children

  • R. V. Pieretti
  • J. Lago
  • R. Pieretti-Vanmarcke
Original Article

Abstract

Strictures of the posterior urethra resulting from pelvic fractures in children pose a formidable challenge due to the limitations of perineal exposure. With the transpubic approach, direct access to the involved anatomy is obtained. This technique, combined with perineal mobilization of the distal urethra, allows the performance of a tension-free anastomosis. The use of an omental pedicle wrap graft seems to add safety to the procedure. It is particularly suited for long strictures and after failure of the transperineal approaches. The results reported in the literature are remarkably good. There are no reports of orthopedic sequelae in children. Sexual potency and continence do not seem to be adversely affected. We present two cases successfully operated upon by this technique.

Key words

Posterior urethral stricture Pelvic fracture Transpuboperineal approach 

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References

  1. 1.
    Allen TD (1975) The transpublic approach for strictures of the membranous urethra. J Urol 114: 63–68PubMedGoogle Scholar
  2. 2.
    Brock WA, Kaplan GW (1981) Use of transpublic approach for urethroplasty in children. J Urol 125: 496–501PubMedGoogle Scholar
  3. 3.
    Burbige KA (1992) Transpubic-perineal urethral reconstruction in boys using a substitution graft. J Urol 148: 1235–1238PubMedGoogle Scholar
  4. 4.
    Cass AS (1984) Urethral injury in the multiple-injured patient. J Trauma 24: 901–906PubMedCrossRefGoogle Scholar
  5. 5.
    Crasweller PQ, Farrow GA, Robson CJ, Russell JL, Colapinto V (1977) Traumatic rupture of the supramembranous urethra. J Urol 118: 770–771Google Scholar
  6. 6.
    Devine CJ, Jordan GH, Devine PC (1989) Primary realignment of the disrupted prostatomembranous urethra. Urol Clin North Am 16: 291–295PubMedGoogle Scholar
  7. 7.
    Khan AU, Furlow W (1976) 7Transpubic urethroplasty. J Urol 116: 447–450PubMedGoogle Scholar
  8. 8.
    MacMahon R, Hosking D, Ramsey EW (1983) Management of blunt injury to the lower urinary tract. Can J Surg 26: 415–418PubMedGoogle Scholar
  9. 9.
    Malek RS, O'Dea MJ, Kelalis PP (1977) Management of ruptured posterior urethra in childhood. J Urol 117: 105–109PubMedGoogle Scholar
  10. 10.
    Morales P, Littmann R, Golimbu M (1973) Transpubic surgery: a new approach to difficult pelvic operations. J Urol 110: 564–570PubMedGoogle Scholar
  11. 11.
    Morehouse DD, Belitsky P, Mackinnon K (1972) Rupture of the posterior urethra. J Urol 107: 255–258PubMedGoogle Scholar
  12. 12.
    Morehouse DD, Mackinnon KJ (1980) Management of prostatomembranous urethral disruption: 13-year experience. J Urol 123: 173–174PubMedGoogle Scholar
  13. 13.
    Paine D, Coombes W (1968) Transpubic reconstruction of the urethra. Br J Urol 40: 78–84PubMedCrossRefGoogle Scholar
  14. 14.
    Peters CA, Hendren WH (1989) Splitting pubis for exposure in difficult reconstruction for incontinence. J Urol 142: 527–531PubMedGoogle Scholar
  15. 15.
    Pierce JM (1962) Exposure of the membranous and posterior urethra by total pubectomy. J Urol 88: 256–258PubMedGoogle Scholar
  16. 16.
    Pierce JM Jr (1972) Management of dismemberment of the prostatic-membranous urethra and ensuing stricture disease. J Urol 107: 259–264PubMedGoogle Scholar
  17. 17.
    Pierce JM (1979) Posterior urethral stricture repair. J Urol 121: 739–742PubMedGoogle Scholar
  18. 18.
    Singh PB, Karmakar D, Cupta RC, Dwivedi US, Tripathi VN (1988) Result of suprapubic cystostomy only as primary management of posterior urethral rupture following pelvic fracture. Int Surg 73: 59–62PubMedGoogle Scholar
  19. 19.
    Turner-Warwick R (1977) Complex traumatic posterior urethral strictures. J Urol 118: 564–574, 1977PubMedGoogle Scholar
  20. 20.
    Waterhouse K (1976) The surgical repair of membranous urethral strictures in children. J Urol 116: 363–365PubMedGoogle Scholar
  21. 21.
    Waterhouse K, Abrahams JI, Gruber H, Hackett RE, Patil UB, Peng BK (1973) The transpubic approach to the lower urinary tract. J Urol 109: 486–490PubMedGoogle Scholar
  22. 22.
    Waterhouse K, Abrahams JL, Caponegro P, Hackett RE, Patil UB, Peng BK (1974) The transpubic repair of membranous urethral strictures. J Urol 111: 188–190PubMedGoogle Scholar
  23. 23.
    Webster GD, Selli C (1983) Management of traumatic posterior urethral stricture by one stage perineal repair. Surg Gynecol Obstet 156: 620–624PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • R. V. Pieretti
    • 1
  • J. Lago
    • 1
  • R. Pieretti-Vanmarcke
    • 1
  1. 1.Tamanaco Urologic Institute and “Dr. Domingo Luciani Hospital”CaracasVenezuela

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