ANASTOMOTIC URETHROPLASTY IN CHILDREN WITH PFUDD
Rajendra Nerli, MD1, Abhijith Musale, Jr., MS2, Shankar K, MS2, Shridhar Ghagane, M.Sc. Ph.D.3.
1KLES Kidney Foundation, Belgaum, India, 2KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi., Belagavi., India, 3KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi., Belagavi., India.
BACKGROUND: A bony pelvic fracture in a child is more likely to be unstable and is invariably associated with a severely and permanently displaced prostatic urethra. The severe displacement of the prostate off the pelvic floor makes a complete posterior urethral disruption more common in boys than in men. An anastomotic urethroplasty using either the perineal, transpubic, transsymphyseal, or combined approach has a reported success of greater than 90% in the pediatric patient population. We report our experience with anastomotic urethroplasty in children with (Pelvic fracture urethral distraction defects -PFUDD).
METHODS: We reviewed the medical charts of 17 male children who underwent excision and end-to-end anastomosis for Pelvic fracture urethral distraction defects/urethral strictures following posterior urethral injury and who completed at least 6 months of follow-up.RESULTS: 21 male children with a mean age of 100.47 months underwent excision and end to end anastomosis for pelvic fracture with urethral distraction defects/posterior urethral stricture. On radiographic evaluation (retrograde and voiding urethrogram) the length of the urethral stricture was 2 cms in 17 (80.9%) and 3 cms in the remaining 4 (19.1%). All the children were explored initially through the perineal access. The two ends could be easily approximated without tension in 14 (66.6%) children. In four other children crural separation with inferior pubectomy was done so as to achieve a tension free anastomosis. In the remaining three children who also had a bladder neck incompetence a perineal incision and a pffannelsteil abdominal incision was used to access the site of stricture and bladder neck. Following removal of the catheter all children voided well with or without a small volume of residual urine.
CONCLUSIONS: Anastomotic urethroplasty in children with PFUDD is safe, effective and associated with good outcome on intermediate term follow-up.
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