Surgical treatment of pelvic fracture urethral distraction defects in boys: which approach is suitable?
Lin Wang1,2,3, Hai-Lin Guo1,2,3, Hui-Quan Shu1,3, Jie Gu1,3, Chong-Rui Jin1,3, Fang Chen1,3, Ying-Long Sa1,3
1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
2 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
3 Shanghai Eastern Institute of Urologic Reconstruction, Shanghai 200233, China
Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai 200233
Source of Support: None, Conflict of Interest: None
Pelvic fracture urethral distraction defects (PFUDDs) are relatively infrequent in boys, and treatment for PFUDDs presents one of the most difficult problems in urological practice. Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys. However, various surgical approaches for anastomotic urethroplasty have been proposed, including a simple transperineal approach, a transperineal intercorporal septal separation approach, a transperineal inferior pubic approach, and a combined transpubic-perineal approach. This study aims to determine which surgical approach is best for PFUDDs in boys. We retrospectively identified 22 boys with PFUDDs aged 2–14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017. Follow-up was performed in all the 22 patients for 6–123 (mean: 52.0) months. Finally, 20 of the 22 boys (90.9%) were successfully treated, including 1 of 2 patients treated with a simple transperineal approach, 3 of 3 with a transperineal approach with intercorporal septal separation, 14 of 15 with a transperineal inferior pubic approach, and 2 of 2 with a combined transpubic-perineal approach. Two patients had failed outcomes after the operation, and stenosis recurred. Based on the outcome of the 22 patients, we can draw a preliminary conclusion that most boys (20/22) can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis. The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.