Aetilogy and Treatment Outcomes of Symptomatic Congenital Cobb's Collar

Abstract

Purpose “Genuine” paediatric posterior urethral strictures are uncommon and their true existence as distinct from posterior urethral valves is questioned. We report on the treatment and outcome of such strictures. Material and Methods Eleven cases over a 9 year period were identified from departmental records and case notes were analysed retrospectively. Results Eleven strictures were identified in a nine year period. The age at presentation had a bimodal distribution, with 6/11 presenting in the first year of life, of which 4 had observed antenatal hydronephrosis. 4/11 presented after the age of 11 years. 1 patient presented aged 3 years. 7 patients underwent optical urethrotomy as the primary treatment which was curative in 42 % and 58% required further intervention with 1 requiring anastomotic urethroplasty, which was considered indicative of failed primary treatment. 3 children were treated by urethral dilatation, of which 66 % required further intervention, and 1 was referred for anastomotic urethroplasty. 1 patient was treated by primary anastomotic urethroplasty with a durable result. Conclusions All patients who underwent, or were referred for anastomotic urethroplasty were older than 13 years. This outcome, in conjunction with the bimodal age distribution at presentation would suggest a different aetiology in older children. Consequently, we would urge caution in classifying strictures in ambulant children as genuinely congenital, as strictures in this population may represent the long term manifestation of unrecorded bulbar urethral trauma received in infancy. We believe that there exists an uncommon group of patients who develop a congenital bulbar stricture which is distinct from posterior urethral valves or post traumatic strictures, which may be a remnant of the cloacal membrane. Optical urethrotomy or dilatation is durable when treated in infancy but older patients do not experience prolonged resolution and we would recommend treatment along adult lines.