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Guide wire-assisted urethral dilation in pediatric urology: experience of a single surgeon
David T Chiang1, Paddy A Dewan
1Department of Pediatric Urology, Sunshine Hospital, Western Health, Melbourne, Australia. davidtwchiang@yahoo.com.au
Insights
Guide wire dilation for pediatric urethral stricture is a safe alternative, but recurrence rates indicate it
Area of Science:
- Pediatric Urology
- Urological Surgery
- Minimally Invasive Procedures
Background:
- Urethral stricture management in children often requires effective dilation techniques.
- Guide wire and sheath dilator dilation offers a less invasive approach.
- Assessing long-term outcomes is crucial for pediatric urethral stricture treatment.
Purpose of the Study:
- To evaluate the long-term efficacy of guide wire-assisted urethral dilation in pediatric patients.
- To determine recurrence rates and complication profiles following the procedure.
- To establish the suitability of this technique for selected cases.
Main Methods:
- A retrospective audit of 52 children with urethral stricture treated between 1999 and 2004.
- Data collected included stricture etiology, surgical details, recovery, and follow-up.
- Follow-up involved cystoscopic assessment and outcome analysis over a mean of 4.5 years.
Main Results:
- 42.3% of patients remained recurrence-free after dilation.
- 25.0% experienced significant stricture progression requiring further intervention.
- Minor complications included UTIs and bladder spasms; no false passage or sepsis occurred.
Conclusions:
- Guide wire-assisted urethral dilation is a safe alternative to blind techniques for pediatric urethral strictures.
- Less than half of patients achieved long-term success after two dilation attempts.
- The procedure should be reserved for selected cases and emergency situations.
Introduction:
A simple technique to dilate urethral stricture using guide wire and sheath dilator has been described in pediatric urology. The aim of this study was to report the long-term outcome of the children who underwent dilation of the urethral stricture using guide wire and sheath dilator.
Materials And Methods:
From 1999 to 2004, a total of 52 children with documented urethral stricture were managed by urethral dilation using guide wire. Data on the cause of urethral stricture, operation, postoperative recovery, follow-up cystoscopic appearance, and patient's outcome were audited and analyzed.
Results:
The mean age of the patients was 5.6 +/- 2.3 years (range, 2 to 18 years). The mean period of the follow-up was 4.5 +/- 2.4 years (range, 3.8 to 6.5 years). Twenty-two patients (42.3%) did not require any further surgical treatments. However, urethral stricture in 13 patients (25.0%) progressed significantly, and therefore, they needed further surgical interventions. The complications included minor urinary tract infections in 3 and bladder spasm in 2 patients. No case of false passage or sepsis was encountered.
Conclusion:
Guide wire-assisted urethral dilation avoids the risks associated with blind dilation techniques and continues to be a safe alternative for urethral strictures in selected cases. However, in our experience, less than half of the patients became "recurrence free" after two dilation attempts. We recommend that urethral dilation be considered only in selected cases and emergency settings.