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Perineal Anastomotic Urethroplasty for Managing Post-Traumatic Urethral Strictures in Children: The Long-Term Outcome
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TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION Editorial Comment: Posterior urethral disruption in boys creates an extremely challenging problem that should only be undertaken by experienced reconstructive surgeons. The limited confines of the perineum in the child and the proximal nature of the injury make an exclusive perineal approach inappropriate. A perineal-transpubic approach provides wide exposure and greater control for complex cases involving long defects or false passage. Interestingly, the 5-year followup reported here suggests that adequate erectile function is maintained in many young men. What is the benefit of acute urethral catheterization after posterior urethral disruption? The debate continues but my 10-year experience has been similar to that of the authors— even when the injured posterior urethra is successfully realigned with a catheter subsequent suprapubic cystostomy and anastomotic urethroplasty are almost always required. Allen F. Morey, M.D.
Perineal Anastomotic Urethroplasty for Managing Post-Traumatic Urethral Strictures in Children: The Long-Term Outcome A. T. Hafez, A. El-Assmy, O. Sarhan, A. S. El-Hefnawy and M. A. Ghoneim, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt BJU Int, 95: 403– 406, 2005 Objective: To evaluate the long-term results of one-stage perineal anastomotic urethroplasty for posttraumatic paediatric urethral strictures. Patients and methods: Thirty-five boys who had a perineal anastomotic urethroplasty for post-traumatic bulbous or posterior urethral strictures between 1991 and 2003 were analysed retrospectively. Patients were followed up for a mean (range) of 46 (6 –132) months by a history, urinary flow rate estimate, retrograde urethrography and voiding cysto- urethrography. Results: The mean (range) age of the patients was 11.9 (6 –18) years. The estimated radiographic stricture length before surgery was 2.6 (1–5) cm. The perineal anastomotic repair was successful in 31 of 35 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in two patients and by repeat perineal anastomotic repair in the remaining two, giving a final success rate of 100%. All boys are continent except two who had early stress incontinence, and that resolved with time. There was no chordee, penile shortening or urethral diverticula during the follow-up. Conclusions: The overall success of a one-stage perineal anastomotic repair of post-traumatic urethral strictures in boys is excellent, with minimal morbidity. Substitution urethroplasty or abdomino-perineal repair should be reserved for the occasional patients with concomitant anterior urethral stricture disease or a complex posterior urethral stricture, respectively. Editorial Comment: Here is the other side of the coin. This group from Egypt reports 100% success with perineal anastomotic repair of posttraumatic urethral strictures in 35 boys. Although an abdominoperineal approach was not performed in this series, I have never regretted it in the tough cases. Allen F. Morey, M.D.
Comparative Study of Dartos Fascia and Tunica Vaginalis Pedicle Wrap for the Tubularized Incised Plate in Primary Hypospadias Repair U. S. Chatterjee, M. K. Mandal, S. Basu, R. Das and T. Majhi, Paediatric Surgery and Urology, Park Children’s Centre for Treatment and Research, New Barrackpore Municipality Hospital, New Barrackpore, and IPGMER and SSKM Hospital, Urology, RG KAR Medical College and Hospital, and Urology, Kolkata, West Bengal, India BJU Int, 94: 1102–1104, 2004 Objectives: To report a prospective comparative study on using dartos fascia, i.e. subcutaneous tissue of penile skin and tunica vaginalis pedicled wrap (TVPW) from the parietal layer of the tunica vaginalis of the testis, for a one-stage tubularized incised-plate (TIP) repair for hypospadias. Patients and methods: Forty-nine patients (mean age 4.6 years, range 1–22) with hypospadias of different types (varying from coronal to penoscrotal) were repaired in one of three hospitals over 3 years. All patients were repaired using
TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION Editorial Comment: Posterior urethral disruption in boys creates an extremely challenging problem that should only be undertaken by experienced reconstructive surgeons. The limited confines of the perineum in the child and the proximal nature of the injury make an exclusive perineal approach inappropriate. A perineal-transpubic approach provides wide exposure and greater control for complex cases involving long defects or false passage. Interestingly, the 5-year followup reported here suggests that adequate erectile function is maintained in many young men. What is the benefit of acute urethral catheterization after posterior urethral disruption? The debate continues but my 10-year experience has been similar to that of the authors— even when the injured posterior urethra is successfully realigned with a catheter subsequent suprapubic cystostomy and anastomotic urethroplasty are almost always required. Allen F. Morey, M.D.
Perineal Anastomotic Urethroplasty for Managing Post-Traumatic Urethral Strictures in Children: The Long-Term Outcome A. T. Hafez, A. El-Assmy, O. Sarhan, A. S. El-Hefnawy and M. A. Ghoneim, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt BJU Int, 95: 403– 406, 2005 Objective: To evaluate the long-term results of one-stage perineal anastomotic urethroplasty for posttraumatic paediatric urethral strictures. Patients and methods: Thirty-five boys who had a perineal anastomotic urethroplasty for post-traumatic bulbous or posterior urethral strictures between 1991 and 2003 were analysed retrospectively. Patients were followed up for a mean (range) of 46 (6 –132) months by a history, urinary flow rate estimate, retrograde urethrography and voiding cysto- urethrography. Results: The mean (range) age of the patients was 11.9 (6 –18) years. The estimated radiographic stricture length before surgery was 2.6 (1–5) cm. The perineal anastomotic repair was successful in 31 of 35 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in two patients and by repeat perineal anastomotic repair in the remaining two, giving a final success rate of 100%. All boys are continent except two who had early stress incontinence, and that resolved with time. There was no chordee, penile shortening or urethral diverticula during the follow-up. Conclusions: The overall success of a one-stage perineal anastomotic repair of post-traumatic urethral strictures in boys is excellent, with minimal morbidity. Substitution urethroplasty or abdomino-perineal repair should be reserved for the occasional patients with concomitant anterior urethral stricture disease or a complex posterior urethral stricture, respectively. Editorial Comment: Here is the other side of the coin. This group from Egypt reports 100% success with perineal anastomotic repair of posttraumatic urethral strictures in 35 boys. Although an abdominoperineal approach was not performed in this series, I have never regretted it in the tough cases. Allen F. Morey, M.D.
Comparative Study of Dartos Fascia and Tunica Vaginalis Pedicle Wrap for the Tubularized Incised Plate in Primary Hypospadias Repair U. S. Chatterjee, M. K. Mandal, S. Basu, R. Das and T. Majhi, Paediatric Surgery and Urology, Park Children’s Centre for Treatment and Research, New Barrackpore Municipality Hospital, New Barrackpore, and IPGMER and SSKM Hospital, Urology, RG KAR Medical College and Hospital, and Urology, Kolkata, West Bengal, India BJU Int, 94: 1102–1104, 2004 Objectives: To report a prospective comparative study on using dartos fascia, i.e. subcutaneous tissue of penile skin and tunica vaginalis pedicled wrap (TVPW) from the parietal layer of the tunica vaginalis of the testis, for a one-stage tubularized incised-plate (TIP) repair for hypospadias. Patients and methods: Forty-nine patients (mean age 4.6 years, range 1–22) with hypospadias of different types (varying from coronal to penoscrotal) were repaired in one of three hospitals over 3 years. All patients were repaired using