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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allen TD (1975) The transpublic approach for strictures of the membranous urethra. J Urol 114: 63–68
Brock WA, Kaplan GW (1981) Use of transpublic approach for urethroplasty in children. J Urol 125: 496–501
Burbige KA (1992) Transpubic-perineal urethral reconstruction in boys using a substitution graft. J Urol 148: 1235–1238
Cass AS (1984) Urethral injury in the multiple-injured patient. J Trauma 24: 901–906
Crasweller PQ, Farrow GA, Robson CJ, Russell JL, Colapinto V (1977) Traumatic rupture of the supramembranous urethra. J Urol 118: 770–771
Devine CJ, Jordan GH, Devine PC (1989) Primary realignment of the disrupted prostatomembranous urethra. Urol Clin North Am 16: 291–295
Khan AU, Furlow W (1976) 7Transpubic urethroplasty. J Urol 116: 447–450
MacMahon R, Hosking D, Ramsey EW (1983) Management of blunt injury to the lower urinary tract. Can J Surg 26: 415–418
Malek RS, O'Dea MJ, Kelalis PP (1977) Management of ruptured posterior urethra in childhood. J Urol 117: 105–109
Morales P, Littmann R, Golimbu M (1973) Transpubic surgery: a new approach to difficult pelvic operations. J Urol 110: 564–570
Morehouse DD, Belitsky P, Mackinnon K (1972) Rupture of the posterior urethra. J Urol 107: 255–258
Morehouse DD, Mackinnon KJ (1980) Management of prostatomembranous urethral disruption: 13-year experience. J Urol 123: 173–174
Paine D, Coombes W (1968) Transpubic reconstruction of the urethra. Br J Urol 40: 78–84
Peters CA, Hendren WH (1989) Splitting pubis for exposure in difficult reconstruction for incontinence. J Urol 142: 527–531
Pierce JM (1962) Exposure of the membranous and posterior urethra by total pubectomy. J Urol 88: 256–258
Pierce JM Jr (1972) Management of dismemberment of the prostatic-membranous urethra and ensuing stricture disease. J Urol 107: 259–264
Pierce JM (1979) Posterior urethral stricture repair. J Urol 121: 739–742
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: 59–62
Turner-Warwick R (1977) Complex traumatic posterior urethral strictures. J Urol 118: 564–574, 1977
Waterhouse K (1976) The surgical repair of membranous urethral strictures in children. J Urol 116: 363–365
Waterhouse K, Abrahams JI, Gruber H, Hackett RE, Patil UB, Peng BK (1973) The transpubic approach to the lower urinary tract. J Urol 109: 486–490
Waterhouse K, Abrahams JL, Caponegro P, Hackett RE, Patil UB, Peng BK (1974) The transpubic repair of membranous urethral strictures. J Urol 111: 188–190
Webster GD, Selli C (1983) Management of traumatic posterior urethral stricture by one stage perineal repair. Surg Gynecol Obstet 156: 620–624
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pieretti, R.V., Lago, J. & Pieretti-Vanmarcke, R. The transpuboperineal approach for repair of traumatic strictures of the posterior urethra in children. Pediatr Surg Int 11, 351–353 (1996). https://doi.org/10.1007/BF00497810
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF00497810