Use of the transpubic approach for urethroplasty in children.

The management of traumatic strictures of the posterior urethra in children poses several problems owing to the limitations of perineal exposure, and the small size and delicacy of the structures involved. We have used a transpubic approach in the repair of strictures of the posterior urethra in 5 children, 4 of whom had previously undergone unsuccessful attempts at repair by other routes. In 2 of the transpubic repairs a patch graft technique was used, and 3 consisted of excision and primary reanastomosis. Two repairs were accompanied by concomitant closure of a failed first-stage Turner-Warwick scrotal inlay. The transpubic approach offered excellent exposure and visualization of the involved anatomy, and facilitated accurate suture placement and tissue realignment in all 5 patients. Final results have been satisfactory in 4 patients. There have been no clinically detectable effects on gait and there have been no significant complications or morbidity associated with this approach.