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Updated: Aug 20, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Long-term outcome of visual internal urethrotomy for the management of pediatric urethral strictures
Ashraf T Hafez1, Ahmed El-Assmy, Mohamed S Dawaba
1Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. athafez@yahoo.com
Insights
Visual internal urethrotomy is a safe initial treatment for pediatric urethral strictures under 1 cm. However, open urethroplasty is preferred for longer strictures or recurrent cases to minimize risk.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Urethral Stricture Management
Background:
- Pediatric urethral strictures can result from various causes, including failed prior surgeries and instrumentation.
- Effective long-term management strategies are crucial for improving quality of life in affected children.
Purpose of the Study:
- To assess the long-term efficacy and outcomes of visual internal urethrotomy (VIU) in pediatric urethral strictures.
- To identify risk factors associated with stricture recurrence after VIU.
Main Methods:
- Retrospective review of computerized surgical records (1980-2001) for children undergoing VIU.
- Analysis of clinical charts for patients with a minimum 2-year follow-up, examining variables like age, etiology, and stricture characteristics.
Main Results:
- Initial VIU success rate was 35.5%; a second procedure improved success to 58.1%.
- Stricture length <1 cm was the only variable associated with favorable outcomes.
- Half of patients requiring multiple VIUs ultimately needed open urethroplasty.
Conclusions:
- Visual internal urethrotomy is a viable first-line option for pediatric urethral strictures <1 cm.
- Open urethroplasty is recommended for strictures >1 cm or those with multiple recurrences due to high risk.
- VIU offers a safe therapeutic approach when indications are carefully considered.
Purpose:
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.
Materials And Methods:
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.
Results:
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.
Conclusions:
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.
