Atypically extended post-traumatic stricture of the bulbous urethra in a teenager: a Case report

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Abstract

Presentation of clinical observation of a patient with an atypically extended stricture of the bulbar urethra.

A 15-year-old boy came to the clinic with complaints of difficult and prolonged urination after an injury to the perineum and scrotum. The patient underwent a 3-fold surgical treatment for an extended stricture of the bulbous urethra. Complete recovery of the patient was achieved after repeated surgical interventions. At follow-up for 2.5 years, he urinates freely and painlessly. The average urination rate is 18 ml/s, urine tests are without deviations according to echography, and adequate emptying of the bladder is noted.

In children, a post-traumatic urethral stricture is a rare condition, and patient management has not been finalized. In most cases, the methods of operations adopted in adult patients are used. Reconstructive surgery in this patient was performed in the “cold” postoperative period. With extended strictures, preference should be given to open urethroplasty, namely, augmentation techniques using a free buccal mucosal graft.

The presented clinical case demonstrates the complexity of determining the therapeutic strategies and the surgical treatment in cases of an extended bulbous urethra stricture.

About the authors

Elizaveta A. Ladygina

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Author for correspondence.
Email: doc.lizaladygina@yandex.ru
ORCID iD: 0000-0002-9916-419X
SPIN-code: 8980-7760

Postgraduate Student

Russian Federation, Moscow

Vasily V. Nikolaev

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma; Pirogov Russian National Research Medical University

Email: vasnik@yandex.ru
ORCID iD: 0000-0001-7815-4825

Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

Nikita V. Demin

Pirogov Russian National Research Medical University; Peoples’ Friendship University of Russia

Email: doc.lizaladygina@yandex.ru
ORCID iD: 0000-0001-7508-5019
SPIN-code: 2757-6028

Cand. Sci. (Med.), Senior Researcher, Associate Professor

Russian Federation, Moscow; Moscow

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Supplementary files

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2. Fig. 1. Urethrogram of the patient at the initial visit

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3. Fig. 2. Ureteroscopy view showing distal urethral stenosis (arrow)

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4. Fig. 3. Stages of the operation of augmentation urethroplasty: a — schematic representation of the surgical approach; b — mobilized bulbous urethra; c — the bulbous urethra is rotated 180 degrees; d — removal of a calculus from the urethra; e — prepared free buccal graft; f — a buccal graft is placed on the albuginea of the cavernous bodies

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5. Fig. 4. Urethrogram on day 10 after dorsal-onlay urethroplasty. The arrows mark the augmented part of the urethra

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6. Fig. 5. Descending urethrography 11 months after urethroplasty. Visualized short stricture and suprastenotic expansion in the bulbous urethra (arrow)

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7. Fig. 6. Urethrogram showing a short stricture in the bulbous urethra (arrow)

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8. Fig. 7. Stages of the Holtsov – Marion urethroplasty operation: a — mobilized part of the urethra, including stricture; b — the urethra was transected at the level of the stricture; c — bugie 20 Ch was inserted into the proximal and distal ends of the urethra; d — uretrouretroanastomosis

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