Transpubic urethroplasty in children: report of 10 cases with review of the literature.

Posttraumatic prostatomembranous urethral strictures (PUS) in children have special features that warrant consideration with respect to management. Transpubic urethroplasty (TPUP) was used to treat 10 children who presented with posttraumatic PUS. All patients previously had unsuccessful repair attempts with other techniques. Urethral stricture was noted in three patients who were cured within a few months by urethral dilatations. Appropriate antibiotic therapy was begun for prolonged urinary infection in four patients. Complete urinary continence was achieved in seven patients (70%), and three (30%) are still incontinent. In the latter, the bladder neck and posterior urethra were reported to have been damaged seriously, owing to extensive dissections at the time of initial treatment. Severe retropubic tissue loss and fibrosis were noted in these patients. Thus, the authors emphasize that avoiding further injury to any of the continence mechanisms that have survived the injury is as important as performing a patent urethral anastomosis. There were no significant complications or morbidity associated with TPUP. TPUP provided excellent exposure and visualization of the involved anatomy and facilitated accurate suture placement and tissue realignment in all patients.