Text Box: THE MANAGEMENT OF OLD TRAUMATIC POSTERIOR URETHRAL INJURY IN BOYS Huang CR, Bai J W, Liang R X, Sun N, and Zhang W P Beijing Children’s Hospital, Beijing, China Objective: The management of traumatic posterior urethral stricture or obliteration in boys is not uncommon and difficult, so we analyze our cases in order to improve and shorten the morbidity. Methods: From 1980 to 2000, there were 228 traumatic posterior urethral injuries. Over 90% were due to traffic accidents. Six boys were postoperative of imperforate anus repair. Mean patient age at referral was 8 years (range 1 to 14). There were 24 fresh cases which including 19 complete urethral disruption, six of them only received cystostomy, so that a delayed second procedure is needed. Meantime there were 204 old traumatic posterior urethral injury were transferred from elsewhere, altogether there were 210 cases. There were 10% (19/210) patients have received over twice operations before admission. Management including transurethral incision (TUI) in 114 cases, including niti spiral stent was used in 50; transpubic combined with perineum urethral repair in 56 cases, including 6 of them were failed TUI patient; only via perineal approach for urethral repair in 34 cases, including 2 of them were failed TUI; perineal urethrotomy were performed either transpubic or/and perineal approach in 15 including 3 of them were failed urethral repair; Mitrofanoff in one; urethra repair through rectal perineal approach in one. Results: The whole series were followed from 3 months to 14 years. Normal urination were got in 187 boys (187/210=89%), incomplete urinary incontinence in 10 , still with perineal urethrostomy in 4 , and one should do clean intermittent catherization. The time is too short for evaluation in 8 patients. Conclusions: The preliminary management is very important for the traumatic posterior urethral injury. In fresh cases simple cystostomy only used for incomplete urethral disruption; end to end anastomosis via perineal approach is indicated in complete urethral disruption. For old urethral injury penetrating and dilatation or TUI is good for majority simple cases. Transpubic combined with perineal approach is indicated for complicated old traumatic posterior urethral stricture or obliteration. The proximal urethral end is long enough for exposure then urethral can be repaired via perineal approach. 1707