Margit Fisch, MD, FEAPU, FEBU, presented “Mechanism of Urethral Injury in Children and Anatomical Limitations for Urethral Reconstruction” during the 44th Annual Ralph E. Hopkins Urology Seminar on February 5, 2025, in Jackson Hole, Wyoming.
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How to cite: Fisch, Margit. “Mechanism of Urethral Injury in Children and Anatomical Limitations for Urethral Reconstruction.” February 5, 2025. Accessed Mar 2025. https://grandroundsinurology.com/mechanism-of-urethral-injury-in-children-and-anatomical-limitations-for-urethral-reconstruction/
Mechanism of Urethral Injury in Children and Anatomical Limitations for Urethral Reconstruction – Summary
Margit Fisch, MD, FEAPU, FEBU, explores the complexities of urethral stricture disease in children, emphasizing the differences in management compared to adults. In this 17-minute presentation, Dr. Fisch explains that pediatric urethral strictures are rare. Diagnosis requires retrograde urethrograms, voiding cystourethrograms, and cystoscopy under anesthesia, with MRI offering additional insights for posterior strictures.
Dr. Fisch explains that treatment outcomes vary based on location and etiology. End-to-end anastomosis is the preferred approach for short strictures, while graft-based repairs using buccal mucosa or skin are viable for more extensive defects when primary anastomosis is not feasible. Posterior urethral strictures, often associated with pelvic trauma, require perineal or transpubic approaches.
She shares that functional outcomes, particularly erectile function and continence, remain underreported, highlighting the need for long-term follow-up. Dr. Fisch underscores the anatomical challenges of pediatric urethral reconstruction, emphasizing the need for specialized techniques to optimize success. She asserts ongoing research is necessary to refine surgical approaches and assess the long-term impact on sexual and urinary function into adulthood.
About The 44th Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, sexual function, emerging surgical techniques, and general urology. The 44th iteration of the meeting took place from February 5th to February 8th, 2025, in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Margit Fisch, MD, FEAPU, FEBU, is Director of the Department of Urology and Pediatric Urology of the University Medical Center Hamburg-Eppendorf. Her major professional interest is reconstructive urology, especially urethral reconstruction and urinary diversion. In cooperation with the Center of Urology and Nephrology in Mansoura, Egypt, she contributed major advances to ureteral implantation and urinary diversion using the anal sphincter, including developing and publishing the “sigma-rectum pouch” technique. In cooperation with the University College in Dublin, Ireland, and Prof. John Fitzpatrick, she created the “transverse colonic pouch” technique, among others.
Dr. Fisch trained with Professor Rudolf Hohenfellner and Joachim W. Thüroff in Mainz, Germany. In 2000 she moved to Hamburg to become Head of the Section of Pediatric Urology at the Asklepios Clinic and became Director of the Department of Urology and Pediatric Urology in 2002. She has held her University of Hamburg position since December 2008. Dr. Fisch is Fellow of the European Board of Urology (FEBU) and the European Academy of Paediatric Urology (FEAPU). She is an elected International Member of the American Association of Genitourinary Surgeons (AAGUS) and the Society of Pelvic Surgeons (SPS). She is a member of the Association of Academic European Urologists (AAEU). She has served as President of the Society of Genito-Urinary Surgeons (GURS) and the European Society of Genito-Urinary Surgeons (ESGURS) and was the first female President of the German Association of Urology (2021 – 2022). Memberships include the European Association of Paediatric Urology (ESPU), Society of Pediatric Urologic Surgeons (SPUS), the European Association of Urology (EAU), the American Association of Urology (AUA), the German Association of Urology (DGU) and the German-Japanese Confederation of Urology. Dr. Fisch has published over 300 papers and book chapters, with over 90 as first author, and she organizes the International Meeting on Reconstructive Urology (IMORU).
Dr. Fisch trained with Professor Rudolf Hohenfellner and Joachim W. Thüroff in Mainz, Germany, and became a staff member at Mainz Medical School in 1992. She served as Vice-Chair of the Department of Urology before moving to Hamburg to become Head of the Section of Pediatric Urology at the Asklepios Clinic in 2000. In 2002, she became Director of the Department of Urology and Pediatric Urology. She has held her University of Hamburg position since December 2008.
Dr. Fisch is Fellow of the European Board of Urology (FEBU) and the European Academy of Paediatric Urology (FEAPU). Additionally, she is Adjunct Scientific Chair and Board Member of the Société Internationale d’Urologie (SIU), and an elected International Member of both the American Association of Genitourinary Surgeons (AAGUS) and the Society of Pelvic Surgeons (SPS). She has served as President of the Society of Genito-Urinary Surgeons (GURS) and the European Society of Genito-Urinary Surgeons (ESGURS).
Memberships include the European Association of Paediatric Urology (ESPU), the American Academy of Pediatrics (AAP), the Society of Pediatric Urologic Surgeons (SPUS), the European Association of Urology (EAU), the American Association of Urology (AUA), the German Association of Urology (DGU), the Panafrican Association of Urology (PAUSA), and the German-Japanese Confederation of Urology.
She has published >300 papers and book chapters, with >90 as first author, and organizes the tri-annual International Meeting on Reconstructive Urology (IMORU).
