Abstract
Pediatric anterior urethral strictures are rare and recommendations regarding treatment strategies derive from small monocentric case series. In 2014, a collaborative effort of the Société Internationale d'Urologie and the International Consultation on Urological Diseases drafted the first systematic and evidence-based guideline for diagnosis and treatment of urethral strictures in children. Against this backdrop, we performed an updated literature review to provide a comprehensive summary of the available evidence and contemporary outcomes with a focus on comparative effectiveness of endoscopic treatment (dilation or urethrotomy) vs. open surgical reconstruction. Overall, 22 articles reporting on children with anterior urethral strictures were included into the review. Most strictures were iatrogenic (48%) and traumatic (34%), whereas congenital (13%), inflammatory (4%), or postinfectious strictures (1%) were rather rare. The cumulative success rate of endoscopic treatment and urethroplasty was 46% (range: 21–75; N = 334) and 84% (range: 25–100; N = 347), respectively. After stratifying patients according to urethroplasty technique, success rates were 82% (range: 25–100; N = 206) for excision and primary anastomosis, 94% (range: 75–100; N = 40) for graft augmentation, 97% (range: 87–100; N = 30) for flap urethroplasty, and 70% (one study; N = 20) for pull-through urethroplasty. In conclusion, endoscopic approaches are rather ineffective in the long-term and open surgical reconstruction via urethroplasty should be preferred to avoid multiple, repetitive interventions. Future research may involve multi-institutional, collaborative, and prospective studies, incorporating well-defined outcome criteria and assessing objective surgical endpoints as well as patient-reported functional outcomes.
Highlights
Anatomic lower urinary obstruction is a rather rare problem in pediatric urology
There are several surgical options at hand for pediatric urethral stricture, the paucity of literature, which is mainly based on small monocentric series, often hampers treatment decisions for this rare disease, when opting for therapeutical sequences, and gauging different strategies
Pediatric anterior urethral strictures are mostly iatrogenically caused of which the majority of cases are hypospadias-associated, followed by traumatic, and congenital strictures
Summary
Anatomic lower urinary obstruction is a rather rare problem in pediatric urology. Whereas, voiding difficulties are commonly diagnosed in boys with urethral valves or hypospadias, the experience in treatment of isolated pediatric anterior urethral strictures is remarkably scarce. Information on pediatric or adolescent strictures is commonly extrapolated from the adult literature [1]. With exception of the collaborative 2014 Société Internationale d’Urologie (SIU) and Treatment of Pediatric Urethral Strictures. Given that urethral stricture disease is relatively rare in adults [3], the incidence in children is even smaller and there is a paucity of experience in patients up to 18 years. Etiology and management in pediatric urethral stricture disease are not well defined. We aimed to provide a contemporary overview of available operative techniques, treatment approaches, and outcomes in this subgroup of patients
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