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Published on: January 7, 2019
Role of visual internal urethrotomy in pediatric urethral strictures
Ene Launonen1, Jukka Sairanen1, Mirja Ruutu1
1Department of Urology, University of Helsinki, Helsinki, Finland.
Insights
Visual internal urethrotomy (VIU) offers a 25% success rate for pediatric urethral strictures. Repeat VIUs or dilatations improve success to 71%, especially for strictures under 2 cm.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Urethral Stricture Management
Background:
- Urethral stricture is a challenging condition in pediatric patients.
- Visual internal urethrotomy (VIU) is a minimally invasive option for treatment.
- Long-term outcomes of VIU in children require further evaluation.
Purpose of the Study:
- To assess the long-term efficacy of VIU as a primary treatment for pediatric urethral strictures.
- To determine factors influencing VIU success rates, including repeat treatments and stricture characteristics.
Main Methods:
- A retrospective review of 34 pediatric patients treated with VIU between 1980 and 2010.
- Evaluation of stricture characteristics, repeat treatment necessity, and long-term follow-up outcomes.
- Analysis of success rates based on repeat VIUs, dilatations, and stricture length.
Main Results:
- Initial VIU success rates ranged from 22-33% at 5 years.
- Overall success rate reached 71% after repeat VIUs or dilatations over a median follow-up of 6.6 years.
- Strictures shorter than 2 cm showed significantly higher success rates (24/29) compared to longer strictures (0/5).
Conclusions:
- Single VIU is effective in approximately one-quarter of pediatric urethral stricture cases.
- Repeat VIUs or dilatations significantly improve treatment success to 71%.
- Shorter strictures (<2 cm) are amenable to multiple VIU attempts, while longer strictures may necessitate open surgical correction.
Purpose:
To evaluate the efficiency of visual internal urethrotomies (VIUs) in pediatric patients.
Patients And Methods:
Thirty-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.
Results:
Each 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.
Conclusion:
Single 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.
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