The P.A.D.U.A. (Progressive Augmentation by Dilating the Urethra Anterior) Procedure for the Treatment of Severe Urethral Hypoplasia

Urethral hydrodistension for management of urethral hypoplasia in prune belly syndrome: long-term results

“…Management of urethral hypoplasia after birth includes progressive augmentation by dilating the urethra anterior (PADUA) [12,13], open reconstruction [15], or more conventional procedures (rapid dilation or urethrotomy) [14]. During the PADUA, sequential urethral dilation by soft urethral catheters is performed.…”

“…The procedure is started with a 3F urethral catheter and completed by gradually increasing the calibers of urethral catheters (up to 10F to 14F) [18]. In 1988, Passerini-Glazel et al [12] introduced the PADUA procedure for management of 8 boys, including 5 with PBS and congenital urethral hypoplasia who had different types of urinary diversions. The results showed improvement in 6 patients (75%); however, 2 needed further treatment modalities such as urethrotomy, which was associated with significant morbidity.…”

“…Thus, no additional force is exerted to pass the angiocatheter, which will reduce the possibility of mechanical traumatization of the urethra. Moreover, this approach is less invasive than conventional procedures, such as urethrotomy, which may be associated with considerable morbidities [12].…”

“…Treatment of urethral hypoplasia in PBS and urethral stricture usually includes gradual or forceful progressive dilation using soft catheter with insertion of stent [12,13], urethrotomy [14], and open reconstruction [15]. However, conflicting results have been reported [16], and multiple future procedures are often needed to obtain success [17].…”

Repair of Hypospadiac Urethral Duplication with Dismembered Urethroplasty

“…An alternative method involves dividing the septum between the two urethras to ease the reconstruction [4] . Rarely, the dorsally located urethra that exits through the glans could be used for urethral reconstruction if it is proven to be in good caliber for the passage of urine and could be catheterized like our case [4][5][6] . The quality of two urethral walls and the presence of the spongiosum tissue is significant to decide if the duplicated dorsal urethra needs be excised or can be utilized for reconstruction of the main, hypoplastic and hypospadic ventral urethra.…”