Pediatric Urethral Strictures Research Articles

Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience

Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience

Presentation, treatment and outcomes of pediatric anterior urethral strictures: 28 years’ experience from a referral center

Pediatric urethral strictures are an uncommon entity, with the anterior urethra being the most common affected location, similar to adults. The, literature on outcomes in these strictures is limited, especially in the non-traumatic group, as most of the studies have included hypospadias related "neourethral" strictures and posterior strictures, thereby making interpretation difficult. It is for these reasons we decided to search our database to identify the different surgical procedures used and analyze the outcomes of interventions in these children and adolescents with anterior urethral strictures. To report the treatment strategies and outcomes in a series of 119 pediatric anterior urethral strictures, identified in a 28-year period in a high-volume tertiary center. A retrospective case-note review of all cases of pediatric anterior urethral strictures was done. Data on the clinical presentation including age at presentation, characteristics of strictures identified, primary intervention and additional secondary procedures and outcomes were collected. We identified 119 boys with anterior urethral strictures with commonest location being the bulbar urethra (60.5%). Sixty patients (50.4%) in this cohort underwent minimally invasive intervention in the form of dilatation or direct visual internal urethrotomy (DVIU) with the rest undergoing open intervention. The primary success rate was 87.1% (101/116) at a median follow-up of 29 (IQR 21-38) months. Idiopathic urethral stricture and iatrogenic strictures had better success rate of 92.5% and 82.1% than traumatic strictures (78.9%) and it was lowest for those traumatic strictures that were treated with DVIU (66.7%). Multifocal strictures had comparatively poorer outcomes (62.5%) compared with penile or bulbar strictures, with worst outcomes (44.4%) in those treated with substitution urethroplasty. Length >1cm, multifocality and treatment with substitution urethroplasty were significantly associated with recurrence. Three boys with strictures associated with anorectal malformations were a particularly difficult group and needed multiple intervention and had poor outcomes. Based on our study, we recommend a minimally invasive approach for short segment, bulbar strictures, especially of idiopathic etiology. For other locations and longer strictures, we recommend urethroplasty. Caution must be exercised to avoid underestimation of the actual pathology of the stricture. Caretakers of children with complete bulbar level blockage associated with anorectal malformations undergoing urethroplasty should be explained about the need for multiple interventions and possibility of poor voiding outcomes.

A Retrospective Survey of Pediatric Urethral Stricture in Isfahan, Iran

BackgroundIn order to ensure maximum recovery, stenosis management of the narrow and fragile tissue of urethra in children should be based on ingenious preserving of adequate urethral caliber.ObjectivesOwing to advancements in pediatric surgery that lead to improving the quality and quantity of life in recent years, it is necessary to evaluate urethral strictures and its management. With this respect, we studied the management of children with urethral strictures in two tertiary hospitals in Isfahan, Iran.MethodsAfter obtaining ethical committee clearance (code number 396454), a retrospective search of the hospital information system was carried out for urethral stricture in children aged up to 15 years from 2008 to 2018. We studied all children who underwent the management for urethral strictures associated with recorded data (ICD-10; n = 35.9). Data were analyzed by SPSS and age, as a continuous variable, was expressed as mean ± standard deviation (SD). A P value of < 0.05 was considered statistically significant.ResultsFor over a period of 10 years, there were 383 children, including 348 boys and 35 girls, with the mean ± SD age of 5.5 ± 3.4 years old. The management strategies for boys with the disease of urethra ranked as: dilation of urethra (n = 99), urethral meatotomy (n = 82), urethral meatoplasty (n = 75), urethrotomy (n = 7) and unspecified management (n = 85). In girls, the ranked values corresponded to dilation of urethra (n = 14), diagnostic ureteroscopy (n = 7), and unspecified management (n = 12). There was a significant difference associated with age in each subgroup. Statistical analysis based on the Kruskal-Wallis test showed a significant difference between the variables (P < 0.0001). The minimum age for urethrotomy in the population studied was 4 years old.ConclusionsIn pediatric, surgical treatment is an optimistic surrogate transaction to take the majority of cases with urethral strictures. As a result, in order to decrease complications such as incontinence, impotency, and surgical risks associated with major reconstructive procedures, proper repair at the appropriate time is recommended.

Etiology and characteristics of pediatric urethral strictures in a developing country in the 21st century

Urethral stricture disease in children is not uncommon as assumed; however, most of the information about the etiology, features, and natural history of pediatric strictures is extrapolations from adult series as the literature on this common entity is sparse, and most of the studies are small series. The current etiology and clinical features of urethral stricture disease in the pediatric population in the developing world were determined. The data of children with urethral stricture disease, who had undergone treatment in the tertiary center from 2001 to 2017, were retrospectively analyzed. After excluding girls, the database was analyzed for clinical presentation, possible causes of stricture, site and number of strictures, and length of stricture and for previous interventions. Subanalysis was performed for stricture etiology by patient age, stricture length, site, previous treatments, and presentation with paraurethral abscess. A total of 195 boys with strictures were identified. The common causes of pediatric urethral stricture were traumatic (36.9%), iatrogenic (31.8%), and idiopathic (28.7%). The anterior urethra was the location of the stricture in 141 patients (72.3%). Iatrogenic causes (due to catheterization, hypospadias repair, and valve fulguration) accounted for the majority of anterior urethral strictures (61/141 or 43.2%). Younger children had a tendency to have an iatrogenic and idiopathic cause for strictures, whereas older children had a traumatic etiology; 18.6% of strictures in children younger than 10 years were secondary to trauma, whereas 44.9% of the strictures in patients older than 10 years were traumatic in origin. Trauma was the major cause of posterior urethral strictures (53/54 or 98.1%) and was always associated with pelvic fracture. Strictures due to lichen sclerosus or infectious cause were rare (5 patients or 2.6%). The length of strictures was longer in pan anterior urethral strictures (mean: 82.0mm) than that of those due to lichen sclerosus (mean: 42.5mm) and in patients who had undergone previous treatment (mean: 28.7mm). Iatrogenic causes such as catheterization and hypospadias repair account for the majority of anterior urethral stricture disease in the pediatric population, especially the younger age-group. However, as the child grows, there is a gradual preponderance of traumatic urethral strictures, including posterior urethral strictures.

Penile fasciocutaneous flap urethroplasty for the reconstruction of pediatric long anterior urethral stricture

Though pediatric urethral stricture is an uncommon urological problem, it is a challenging urological one. The causative factors are iatrogenic, traumatic, and inflammatory. In the current study, the authors report their experience of the treatment of pediatric long anterior urethral stricture using penile circular fasciocutaneous flap. The study included 23 pediatric patients who had long anterior urethral strictures, which were repaired using circular penile fasciocutaneous flap. The flap was elevated through a subcoronal circumferential incisionand then it was split ventrally. The strictured portion of the urethra was sharply incised ventrally, extending to 1cm into normal urethra. The flap was sutured to the urethral plate over silicone catheter of suitable size, which was removed after 3 weeks. The follow-up was scheduled every 3 months for the first year and then yearly thereafter. The urethroplasty was successful in 20 cases (86.96%). There were two cases complicated by stricture recurrence, which was managed by visual internal urethrotomy. Fistula formation was reported in one case and was repaired by simple excision and closure. Penile skin necrosis was reported in only one patient and was managed by frequent dressing. During the last five decades, there was a substantial advancement in the reconstruction of long or complex anterior strictures due to the use of grafts and flaps. During pediatric urethral stricture repair, particular attention must be paid to the differences between adults and children anatomy, e.g. the small urethral lumen and tissue delicateness. McAninch introduced the reconstruction of complex anterior urethral strictures utilizing circular penile fasciocutaneous flap. The technique of penile fasciocutaneous flap urethroplasty takes long time and requires meticulous dissection. Therefore, it should be restricted for long or complex anterior urethra strictures. Success rate in this study was 86.96%, which is in the same league as that reported in literature as regard adults penile fasciocutaneous flap urethroplasty. Whitson etal. reported success rates of 84% and 79% in the 5th and 10th years, respectively. In another study, Kim etal. revealed a success rate of 68.9%. In this study, complications incidence was 21.6%, which is consistent with reported incidence of complications of adults penile fasciocutaneous flap urethroplasty (8%-20%). According to the outcomes of this study, penile fasciocutaneous flap urethroplasty is a reasonable modality for the reconstruction of long anterior urethral stricture in pediatric patients especially after circumcision.

Stricture Urethra in Children: An Indian Perspective.

Background:Pediatric urethral stricture and its treatment have functional implications in the growing child.Subjects and Methods:A retrospective study of records on urethral strictures encountered in our institution between January 2005 and May 2016 yielded 23 boys against a backdrop of 19,250 admissions during the same period; stenosis and strictures after hypospadias repair were not included in this study. Demographic data were collected from the charts, and the success of repair was assessed clinically by success of repair was assessed clinically by observing for presence or absence of symptoms such as dribbling, straining at voiding, adequacy of urinary stream and radiologicaly by assessing the micturition phase of voiding cystourethrogram. Success was defined as successful initiation, flow, and completion of voiding with radiological evidence of reestablishment of urethral continuity.Results:The most common cause of urethral stricture was perineal or pelvic trauma (56.5%). Three after surgery for anorectal malformation (13.04%) and 2 (8.6%) followed otherwise unspecified urethritis. Transperineal and transpubic anastomotic routes were used for surgery. Redo surgery was required in 47.8%. The overall success rate was 82%. A self-catheterizable mitrofanoff channel was created as part of the primary procedure in 63.6% (7/11) or after the failure of the first procedure in 36.3% (4/11).Conclusion:The majority of urethral strictures are long-segment strictures or those with complete disruption not amenable to endoscopic techniques. The aim of the surgery is to obtain end-to-end opposition of healthy proximal and distal urethra. The route – transperineal or transpubic – which will give the best access to the ends of the urethra is determined by the location and extent of the stricture and the alteration in anatomy as a consequence of the pelvic fracture. Even after the introduction of laser and endoscopic techniques, surgical repair is required to tackle the majority of urethral strictures in children.

The use of pedicled prepucial skin flap urethroplasty for proximal bulbomembraneous urethral stricture in children

Objective: Pediatric urethral strictures are not uncommon, and a myriad of treatment options is available. The use of pedicled prepucial skin to augment a narrowed urethra is one of the useful methods. In this study, we describe the successful use of this technique in three children with stricture of the proximal bulbomembranous urethra. Materials and methods: In this study, we reviewed three children aged 4, 7, and 10 years, respectively, with proximal bulbomembranous urethral stricture, who were treated at Christian Medical College, Vellore, India, between 2012 and 2014, using a pedicled prepucial skin flap. Results: The mean follow-up time was 28 months (range: 20–41 months). There were no intraoperative or postoperative complications. All three children were symptom-free with a good urinary stream at last follow-up. Conclusion: The pedicled prepucial flap technique for proximal bulbomembranous urethral stricture in children is simple and easy to perform with good overall outcome. Keywords: children, prepucial flap, urethral stricture, urethroplasty

Use of holmium laser for urethral strictures in pediatrics: A prospective study

The management of urethral strictures is very challenging and requires the wide expertise of different treatment modalities ranging from endoscopic procedures to open surgical interventions. To assess the effectiveness and complications of retrograde endoscopic holmium: yttrium-aluminum-garnet laser (Ho: YAG) urethrotomy (HLU) for the treatment of pediatric urethral strictures. From January 2010 to January 2013, 29 male pediatric patients with a mean age of 5.9 years and primary urethral strictures 0.5-2 cm long were treated using HLU. The stricture length was <1 cm in 16 (55%) patients and >1 cm in 13 (45%). Fifteen (51.7%) patients had an anterior urethral stricture, while 14 (48.3%) had a posterior urethral stricture. No positive history was found in 14 (48.3%) patients for the stricture disease, while six (20.7%) had straddle trauma and nine (31%) had an iatrogenic stricture. All of the patients were pre-operatively investigated and at 3 and 6 months postoperation by uroflowmetry and voiding cystourethrography (VCUG). If there were suspicious voiding symptoms, selective uroflowmetry and VCUG were performed at 12 months postoperation. The mean operation time was 31.7 min (20-45 min). Twenty-three (79.3%) and 18 (62.1%) patients showed normal urethra on VCUG with improvement of symptoms at 3 and 6 months, respectively. Thus, recurrence was 37.9% after 6 months of follow-up. The mean pre-operative peak urinary flow rate (Qmax) was 6.47 ml/s. The mean postoperative Qmax at 3 and 6 months was 17.17 ml/s and 15.35 ml/s, respectively. The success rate and flowmetry results did not show any statistical significance in relation to site, length and cause of the strictures. The other 11 patients who failed to improve underwent repeated HLU sessions: 4/11 (36.3%) achieved successful outcomes. Among the seven patients with failed HLU for the second time, a third session was conducted. However, only one patient (14.2%) was cured, while open repair was needed for the remaining six. One study has previously been published on the management of pediatric urethral strictures using HLU. The present results are similar to short-term studies after a single session of visual internal urethrotomy using cold knife (VIU). In the present study, the length, location and cause of strictures did not significantly affect the results. However, the outcomes with strictures <1 cm were better than strictures >1 cm, although patients with strictures >2 cm were excluded. In the present study, the success rates among patients with second and third sessions of HLU were 36.3% and 14.2%, respectively. This was similar to other studies, which reported low success rate with the second session of VIU. The present study was limited by the relatively short period of follow-up and the small number of patients. However, it was the first prospective study evaluating HLU for pediatric strictures. The use of flowmetry and VCUG for evaluation of all patients added to the strength of the study. HLU can be safely used with good success rates for the treatment of primary urethral strictures (<2 cm) in children. Repeat HLU (more than twice) adds little to success.

Role of visual internal urethrotomy in pediatric urethral strictures

PurposeTo evaluate the efficiency of visual internal urethrotomies (VIUs) in pediatric patients. Patients and methodsThirty-four patients aged 0.2–16.3 years were treated with VIUs as a primary treatment for urethral stricture at our institution during 1980–2010. The stricture characteristics and need for repeat treatments as well as the results of repeat VIUs or dilatations were evaluated in a long-term follow-up. ResultsEach time first VIUs or repeat treatments were carried out there was a 22–33% success rate at 5 years. Twenty-four patients (71%) were treated successfully after repeat VIUs or dilatations at a median of 6.6 years' follow-up. None of the five patients with strictures longer than 2 cm were successfully treated, compared with 24 of 29 patients with shorter strictures (p = 0.001). However, stricture etiology or location did not have an impact on success. Currently four patients have undergone an open operation because of stricture and six patients are on a home dilatation program. ConclusionSingle VIU is successful for about one-quarter of pediatric patients with a urethral stricture. With repeated VIUs or dilatations 71% of the patients can achieve success. In strictures less than 2 cm, up to three VIUs can be attempted, but longer strictures need open correction if the patient does not wish to follow the home dilatation program.

Predictors for recurrence after urethroplasty in pediatric and adolescent stricture urethra

ObjectiveThis study aims at evaluating factors predicting recurrence of urethral stricture following urethroplasty in pediatric patients at a tertiary care center. Patients and methodsFifty-two patients of up to 18 years of age, who underwent urethroplasty, were reviewed. Duration of symptoms, etiology, previous intervention, and site of stricture, surgical modality, stricture length, and spongiofibrosis at stricture site, recurrence, and ancillary procedures required were recorded. ResultsForty-two (82.76%) patients (Group I) had recurrence-free course on follow-up. Of the 10 patients with recurrence (Group II), 9 had PTS and 1 had IS (p = 0.04). Most of the factors evaluated did not differ statistically between the groups; however, length of stricture (1.8 vs. 4.3 cm, p < 0.001) and degree of spongiofibrosis (61% vs. 90%, p = 0.003) were significantly different. Seven patients with recurrence were managed with single procedures, but three required multiple procedures because of multiple recurrences. History of incision and drainage for paraurethral abscess was significantly higher (28.6% vs. 100%, p = 0.002) in patients who had multiple recurrences. ConclusionsEtiology, fibrosis at local site, and stricture length have significant impact on recurrence of pediatric urethral stricture disease. Associated paraurethral abscess may further compromise the outcome of urethroplasty.

A Case of Idiopathic Pediatric Urethral Stricture Managed with Modified Buccal Mucosa Graft Urethroplasty: A Case Report

A Case of Idiopathic Pediatric Urethral Stricture Managed with Modified Buccal Mucosa Graft Urethroplasty: A Case Report

Pediatric and adolescent transperineal anastomotic urethroplasty

Purpose Pediatric urethral stricture disease represents a significant surgical challenge because of smaller pelvic confines, decreased caliber and increased tissue fragility. Operative series of pediatric urethral reconstruction usually involve small numbers. In this study, we examined the outcome of open reconstructive techniques for pediatric and adolescent patients with posterior urethral distraction injuries. Patients and methods Between February 2002 and September 2005, 15 patients from Kasr ElAini hospital presenting with posterior urethral distraction defects due to motor vehicle accidents were included in our study. Their age ranged between 5 and 17 years (mean 12.5). We used the progressive perineal approach to achieve a tension-free spatulated anastomosis. Results Mean follow-up was 28.4 months. Initial and ultimate success rates were 80 and 86.6%, respectively. Other than re-stricture, one child had a bladder stone treated by cystolithotomy 6 months after surgery. No penile curvature, shortening or urethral diverticulae were noted during follow-up. Conclusion Using the appropriate modern guidelines of urethroplasty, consistent success can be achieved in pediatric and adolescent patients with posterior urethral injuries. Open urethral reconstruction of adolescent and pediatric strictures provides excellent long-term results with minimal morbidity. Urethral reconstruction is strongly recommended as the primary treatment option, especially in the pediatric urethral stricture population, because of the repair durability.

LONG-TERM OUTCOME OF VISUAL INTERNAL URETHROTOMY FOR THE MANAGEMENT OF PEDIATRIC URETHRAL STRICTURES

We evaluated the long-term results of visual internal urethrotomy for pediatric urethral strictures to evaluate the efficacy and final outcome of this procedure in children and to evaluate the risk factors for stricture recurrence. The computerized surgical records of our hospital were reviewed to identify children who underwent visual internal urethrotomy between 1980 and 2001. Hospital and followup clinical charts were then reviewed. Many variables were analyzed, including age, etiology, length and site of the strictures, and catheter duration. Only patients with a minimum followup of 2 years were included. Regular self-catheterization was not used by any child. A total of 31 patients (mean age 11.2 years, range 2 to 18) were identified. Followup ranged from 2 to 20 years, with a mean of 6.6 years. The most common etiology for stricture formation was failed previous urethroplasty and post instrumentation (35.5% and 32.3%, respectively). The success rate after initial urethrotomy was 35.5% (11 of 31 patients). Mean interval to first recurrence was 26 months. A second urethrotomy improved the success rate of 58.1%. Eight patients required 2 or more urethrotomies, of whom half required open urethroplasty. Among the evaluated variables only stricture length shorter than 1 cm was associated with good results. Visual internal urethrotomy provides a safe first line therapeutic option for pediatric urethral strictures shorter than 1 cm, independent of etiology and location. For patients with more than 1 recurrence or with strictures longer than 1 cm, who are at high risk for recurrence after internal urethrotomy, open urethroplasty remains the treatment of choice.

Direct Vision Internal Urethrotomy for the Treatment of Pediatric Urethral Strictures: Analysis of 50 Patients

In an attempt to evaluate our experience with the treatment of pediatric urethral stricture disease we performed a retrospective review of patients undergoing direct vision internal urethrotomy (DVIU). The computerized surgical logs at 2 pediatric hospitals were reviewed to identify patients who underwent DVIU between 1992 and 2001. Hospital and clinical charts were then reviewed. Many variables were analyzed, including patient age, etiology of stricture, technique and clinical outcomes. Minimum followup to be included in clinical outcome analysis was 12 months. A total of 50 patients were identified (mean age 7.7 years, range 6 months to 17 years). The most common etiology for stricture formation was previous hypospadias repair (20 patients [40%]). Forty patients met the 12-month minimum followup requirement for clinical outcome analysis. Of these patients 20 (50%) had no symptoms to suggest recurrent stricture at a median of 2.0 years (mean 2.7 years, range 12 months to 7 years). Seventeen patients (42.5%) had symptoms of recurrent stricture at a median of 8 months (mean 13 months, range 2 months to 5 years). Technical factors did not influence the ultimate success or failure of the procedure. DVIU provides a therapeutic option that successfully treats approximately half of the patients with a reasonably low complication rate. Complications following DVIU should not preclude its use as a therapeutic modality for the treatment urethral strictures in children. If the child fails the initial DVIU, repeat attempts at endoscopic correction of urethral stricture should be abandoned in favor of definitive urethroplasty.

Open Reconstruction of Pediatric and Adolescent Urethral Strictures: Long-term Followup

Pediatric urethral stricture disease represents a significant surgical challenge. Published operative series of pediatric urethral reconstruction include small numbers or lack long-term followup. We examined the long-term outcome of open reconstructive techniques for pediatric urethral strictures. From March 1987 through August 2002, 17 boys 7 to 17 years old underwent open urethral reconstruction with followup. Trauma was the etiology in 88% of cases. Nine patients had anterior urethral stricture and 8 had traumatic posterior urethral disruption. Strictures secondary to failed hypospadias correction were not included in analysis. In 10 patients (59%) previous management with open or endoscopic procedures had failed. Followup in all patients consisted of symptomatic evaluation, voiding cystourethrography and flexible urethroscopy. One-stage perineal urethral reconstruction was performed in all patients without retropubic or transpubic dissection. All patients were stricture-free and continent at a mean followup of 67 months. A total of 18 open surgical procedures were needed. A patient with posterior urethral disruption required reoperation for recurrent stricture disease but had excellent long-term results after the second operation. Chordee, penile shortening and urethral diverticula were not noted during followup. Open urethral reconstruction of adolescent and pediatric strictures provides excellent long-term results with minimal morbidity. When considering the importance of repair durability in the pediatric urethral stricture population, urethral reconstruction should be strongly considered the primary treatment option. Endoscopic procedures should be reserved for patients with short bulbar strictures associated with minimal spongiofibrosis. As in the literature, we do not advocate repeat direct vision internal urethrotomy.

Congenital Urethral Stricture

No AccessJournal of UrologyPEDIATRIC UROLOGY: SOCIETY FOR FETAL UROLOGY1 Sep 2002Congenital Urethral Stricture Thomas S. Lendvay, Edwin A. Smith, Andrew J. Kirsch, and Mark Boddy Thomas S. LendvayThomas S. Lendvay More articles by this author , Edwin A. SmithEdwin A. Smith More articles by this author , Andrew J. KirschAndrew J. Kirsch More articles by this author , and Mark BoddyMark Boddy More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64616-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Congenital Urethral Stricture." The Journal of Urology, 168(3), pp. 1156–1157 References 1 : Congenital obstruction of the posterior urethra. J Urol1919; 3: 289. Link, Google Scholar 2 : Congenital malformations of the urinary tract. New York: Praeger Publishers1983: 96. Google Scholar 3 : Urethral strictures in boys. J Urol1979; 121: 217. Link, Google Scholar 4 : Congenital urethral membrane causing urethral obstruction. J Urol1974; 111: 250. Link, Google Scholar From the Department of Urology, Section of Pediatric Urology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Bal H, Kurian J and Sen S (2017) The use of pedicled prepucial skin flap urethroplasty for proximal bulbomembraneous urethral stricture in childrenAnnals of Pediatric Surgery, 10.1097/01.XPS.0000503400.13933.ce, VOL. 13, NO. 1, (38-42), Online publication date: 1-Jan-2017. Johnson M, Brandes S and Coplen D (2014) Pediatric Urethral Strictures Advanced Male Urethral and Genital Reconstructive Surgery, 10.1007/978-1-4614-7708-2_37, (519-529), . Levin T, Han B and Little B (2007) Congenital anomalies of the male urethraPediatric Radiology, 10.1007/s00247-007-0495-0, VOL. 37, NO. 9, (851-862), Online publication date: 1-Sep-2007. Krishnan A, de Souza A, Konijeti R and Baskin L (2018) The Anatomy and Embryology of Posterior Urethral ValvesJournal of Urology, VOL. 175, NO. 4, (1214-1220), Online publication date: 1-Apr-2006. Volume 168Issue 3September 2002Page: 1156-1157 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsurogenital abnormalitiesurethral stricturecongenital, hereditary, and neonatal diseases and abnormalitiesurethraMetricsAuthor Information Thomas S. Lendvay More articles by this author Edwin A. Smith More articles by this author Andrew J. Kirsch More articles by this author Mark Boddy More articles by this author Expand All Advertisement PDF downloadLoading ...

Anastomotic Urethroplasty For Bulbar Urethral Stricture: Analysis Of 168 Patients

We reviewed our experience with anastomotic urethroplasty for anterior urethral stricture. A chart review revealed 168 patients 6 to 82 years old (mean age 38) with at least 6 months of followup (mean 70, range 6 to 291) after anastomotic urethroplasty. Average stricture length was 1.7 cm. Of the 168 patients stricture recurred in 8 (5%) but was managed by direct vision internal urethrotomy or a single dilation in 5, while repeat urethroplasty was required in 3 (2%). In these 3 cases extenuating circumstances included patient dislodgment of the catheter with attempts to replace it that disrupted repair, a history of urethrocutaneous fistula and periurethral abscess, and previous irradiation complicating the stricture in 1 each. Other complications were uncommon, such as transient thigh pain or numbness in 3 patients (2%), small wound dehiscence in 2 (1%), and scrotal hematoma, erectile dysfunction and self-limited pulmonary edema in 1 (less than 1%) each. Anastomotic urethroplasty for anterior stricture has a high success rate of 95%. It is technically straightforward and complications are uncommon. Cure by anastomotic urethroplasty should be strongly favored over long-term management by direct vision internal urethrotomy or dilation.

Urethral syndromes in children.

1. Walid Farhat, MD* 2. Gordon McLorie, MD* 1. 2. *Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Objectives After completing this article, readers should be able to: 1. Describe the evaluation of a child suspected of having urethritis. 2. Delineate the screening tests that have the highest yield for urethritis in young children. 3. List components of a behavioral modification approach to treating dysfunctional voiding. 4. Compare and contrast physical findings in gonococcal and nongonococcal urethritis. Inflammation of the urethra (urethritis) may be due to infection, trauma, allergy, foreign body, or an undetermined factor. Certain characteristics distinguish urethritis in the pediatric population from that in adults. First, urethritis in adults and adolescents has an infectious etiology and always is the result of sexual contact; infectious urethritis in the pediatric age group is uncommon, except in sexually active adolescents or children who have been sexually abused by an adult who has the disease. Second, the variability and nonspecificity of a variety of noninfectious urethral pathologies may mimic infectious urethritis in children. Children who have urethritis may present with irritative voiding symptoms, such as dysuria, urgency, or frequency; possible urethral discharge; initial hematuria; or blood spotting on the underwear. Patients suspected of having urethritis are evaluated with a detailed history, physical examination, urethral smear, or urine culture. In girls, examination may show evidence of vaginitis, which is a common cause of dysuria after urinary tract infection, labial adhesions, or even sexual abuse; in males, results of the examination frequently are inconclusive. In infants, young children, and sexually inactive adolescents, screening tests that have the highest yield include urinalysis and abdominal ultrasonography (US); uroflow is reserved for toilet-trained children. The urine should be examined for evidence of infection or hematuria. Abdominal US can diagnose a variety of abnormalities, including bladder stone or inflammation, ureterocele, foreign body, or tumor. Uroflow is a noninvasive urodynamics test that assesses the ability to initiate voiding on command, quantitates …

Treatment of pediatric urethralstricture disease with the neodymium:Yttrium-aluminum-garnet laser

Objectives The aim of this study was to assess the efficacy and safety of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in the treatment of pediatric urethral stricture disease. Methods Twelve boys who had previously undergone unsuccessful cold-knife internal urethrotomy or serial urethral dilation for urethral stricture disease underwent endoscopic laser internal urethrotomy utilizing a contact-tip fiber for recurrent urethral stricture. Results At a mean follow-up of 12 months, 10 of the 12 boys are free of stricture disease for an overall success rate of 83%. Two boys were considered failures and underwent successful open urethroplasty. There were no treatment complications. Conclusions The Nd:YAG laser utilizing the contact-tip fiber was successful in treating recurrent urethral stricture disease. The hemostatic characteristic of the laser allowed bloodless urethrotomy, which was particularly useful when operating with the smaller pediatric endoscopic instruments.