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.