Transperineal End-to-end Anastomotic Urethroplasty for Traumatic Posterior Urethral Disruption and Strictures in Children

Objective: To report the long-term results of transperineal end-to-end anastomotic urethroplasty for post-traumatic posterior urethral stenosis in children.

Methods: From 1975 to 1996, 25 boys [aged 3 to 12 years] with post-traumatic posterior urethral stenosis or obliteration, and one boy [aged 7 years] with disrupted posterior urethra were treated with transperineal end-to-end anastomotic urethroplasty. Final follow-up assessments including voiding status, urinary continence and erectile function were performed in June 1999.

Results: Smooth voiding was restored in 25 boys postoperatively. one child failed an ill-prepared repair and was waiting for further intervention. Among the 25 patients, seven were lost to the final follow-up. All seven boys had a single urethroplasty for simple urethral stenosis and had been followed for 3 to 5 years postoperatively with smooth voiding. The other 18 boys, including seven with complex urethral stenosis [three with a history of failed previous urethroplasties, three with urethrorectal fistula and one with urethroperineal fistula], underwent a total of 22 end-to-end anastomotic urethroplasties [one successful primary repair, 17 successful delayed repairs and four failed repairs]. Of the 17 patients with successful delayed repair, 14 succeeded with one repair, two with two repairs and one with three repairs. The success rate per repair for simple urethral strictures was 94.7% [18 of 19], and for complex strictures 63.6% [7 of 11]. Stress incontinence was found in three cases, impotence in two. Concomitant impotence and stress incontinence were found in one of the five patients.

Conclusion: Transperineal end-to-end anastomotic urethroplasty can achieve good long-term outcomes in children with simple post-traumatic posterior urethral stenosis. In experienced hands, good results can also be achieved for complex urethral strictures.