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Published on: January 7, 2019
Early versus delayed internal urethrotomy for recurrent urethral stricture after urethroplasty in children
Seyyed Yousef Hosseini1, Mohammad Reza Safarinejad
1Department of Urology, Shaheed Modarress Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Early internal urethrotomy is more effective than delayed treatment for managing recurrent urethral strictures in boys after posterior urethroplasty. This approach offers a better stricture-free rate in pediatric patients.
Area of Science:
- Pediatric Urology
- Surgical Management
- Urethral Strictures
Background:
- Recurrent urethral strictures pose a challenge in pediatric patients post-urethroplasty.
- Internal urethrotomy is a potential complementary treatment for these strictures.
Purpose of the Study:
- To compare the efficacy of early versus delayed internal urethrotomy.
- To evaluate outcomes for recurrent urethral strictures after posterior urethroplasty in children.
Main Methods:
- Retrospective analysis of 20 boys with posterior urethral strictures treated with urethroplasty.
- 12 patients underwent internal urethrotomy, divided into early (within 6 weeks) and delayed (after 12 weeks) groups.
- Cold knife internal urethrotomy was used as a complementary treatment with a 5-year mean follow-up.
Main Results:
- The stricture-free rate was significantly higher with early internal urethrotomy (66.6%) compared to delayed (33.3%).
- Statistical significance was observed (P = .03).
Conclusions:
- Early internal urethrotomy demonstrates superior outcomes for recurrent urethral strictures in pediatric patients post-urethroplasty.
- Consideration of early intervention is recommended for improved management of pediatric urethral strictures.
Introduction:
Our aim was to evaluate the results of early versus delayed internal urethrotomy for management of recurrent urethral strictures after posterior urethroplasty in children.
Materials And Methods:
Twenty boys with proven posterior urethral strictures were treated by perineal posterior urethroplasty. Of these, 12 required internal urethrotomy. Each radiograph demonstrated a patent but irregular urethra with a decrease in diameter at the point of repair (fair results). Patients were then divided into 2 groups: 6 underwent early (within 6 weeks from urethroplasty), and 6 underwent delayed (after 12 weeks from urethroplasty), internal urethrotomy with the cold knife as a complementary treatment. The groups were comparable in terms of patient age, etiology of the primary urethral stricture, number of recurrences, length and site of the actual stricture, and preoperative maximum flow rate. Mean follow-up was 5 years.
Results:
Kaplan-Meier analyses showed that the stricture-free rate was 66.6% after early, and 33.3% after delayed, internal urethrotomy (P = .03).
Conclusion:
Early internal urethrotomy should be considered in boys with recurrent urethral stricture after urethroplasty.
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