The P.A.D.U.A. (progressive augmentation by dilating the urethra anterior) procedure for the treatment of severe urethral hypoplasia

Abstract

Eight boys with congenital urethral hypoplasia and atresia are described, including 5 with a patent urachus, 2 with an "H" type urethral perineal duplication and 1 with a rectovesical fistula. Of the boys 5 had the prune belly syndrome. The technique of gradual progressive indwelling soft catheter or stent dilation achieved excellent results in 6 boys. This technique is believed to offer the slow stimulus necessary for urethral dilation that is missing in boys with a patient urachus or urethral duplication. The remaining 2 boys were treated with more conventional techniques of urethrotomy or rapid urethral dilation. They eventually achieved a satisfactory result but after significant morbidity. This clinical experience serves to describe and demonstrate how the application of gradual progressive soft, small catheter or stent dilation of severe urethral hypoplasia and atresia results in a functionally normal urethra with minimal morbidity.