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Pull-through urethroplasty is appropriate for acute or delayed treatment of lesions of the membranous and proximal bulbar urethra. the length of the stricture itself appears to be more important in predicting success than the precipitation event which produces the stricture.

A study is made of 20 children suffering from postraumatic, urethral stenosis and they compare the different techniques used in repairing it. Different methods have been proposed but all produce poor results and doubts always arise in a specific case. The stenoses presented in our study occurred at different levels; four in the bulbar urethra and 16 in the membranous urethra. The patients have been divided into four groups, according to the surgical technique applied. The results have been assessed according to the functioning, radiological aspect and the absence or presence of urinary infection. With reference to the functional aspect, 89.5% presented good results, which is greater than those registered in adults. The explanation may lie in the better, local conditions at the time of surgery and the fact that none of these stenoses were of inflammatory origin.

Thirty-one patients with urethral stricture were subjected to internal urethrotomy under visual control. The patients were divided into two groups according to the surgical procedure: electrosurgical or cold resection. A modification of the Sachse knife was introduced in order to permit its use with the American Cystoscope Makers Inc. instruments. The success rate with cold resection was 81.81% and with the electrosurgical procedure 40%. Internal urethrotomy with cold resection is a simple and harmless operation, being a first choice in the treatment of urethral stricture.

The management of strictures of the posterior urethra is reviewed in 75 adults and 19 children. Of the patients 66 were treated by a perineal pull-through technique and 28 underwent a transpubic approach. The transpubic approach provided excellent exposure to the damaged urethra with minimal morbidity, and good results were obtained in 89 per cent of the children and 69 per cent of the adults. Three patients had partial incontinence postoperatively but 2 recovered completely after 6 months. With the perineal pull-through technique, good results were achieved in 80 per cent of the children and 66 per cent of the adults. Worsening of sexual function was not seen in either treatment group as a consequence of the operation. As a result of this experience the transpubic approach is preferred in cases of complex urethral strictures, cases in which the length of the damaged urethra exceeds 3 cm. or in small children, reserving the pull-through technique for low-lying urethral strictures less than 3 cm. long.

Seven cases of anterior urethral stricture were studied. The diagnosis was made by exclusion of the inflammatory and traumatic causes. In three cases the stricture was located in the bulbar and in four cases in the penile urethra. The results obtained were good, with a follow-up of 5 to 50 months. Considerations are made about embryogenic, diagnostic, clinical picture and treatment. The verification of extensive lesions of the urethra determined the use of more complex surgical techniques of Johansen's urethroplasty devised for the treatment of this kind of pathology.