Pediatric Urethral Strictures

Abstract

Pediatric urethral strictures are uncommon and there is a paucity of published series examining their management. Like their adult counterparts, pediatric urethral strictures can be a result of congenital, iatrogenic, inflammatory, traumatic, or idiopathic etiologies. Meatal stenosis should be managed by meatotomy or meatoplasty. Dilation typically fails and is thus discouraged.Urethrotomy and dilation are acceptable for short bulbar urethral strictures or as salvage after failed urethroplasty with stenotic annular rings. Repeat urethrotomy is futile and potentially harmful. Anterior urethral strictures of the bulb can be successfully managed by anastomotic urethroplasty if short and substitution urethroplasty (buccal grafts) if long. Most posterior urethral strictures that result from pelvic fracture can be successfully repaired by anastomotic urethroplasty via a perineal approach. A transpubic or partial pubectomy posterior anastomotic urethroplasty is occasionally needed when the urethral defect is long or the anastomosis is under tension. Perineal urethroplasty in the child is often technically difficult because the perineal space is confined, the urethra and prostate small, and overall exposure compromised (compared to the adult). For strictures of LS etiology, hypospadias cripples, and after prior failed urethroplasty, a staged urethroplasty is often the best management.KeywordsPelvic FractureUrethral StricturePosterior Urethral ValveLichen SclerosisUrethral InjuryThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.