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Urethral strictures in children, often caused by iatrogenic factors, require advanced surgical techniques. One-stage urethroplasty offers a higher success rate than staged procedures for treating pediatric urethral strictures.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Urethral Stricture Management
Background:
- Urethral strictures are a significant concern in pediatric patients, with diverse etiologies.
- Iatrogenic causes represent the most frequent etiology in this pediatric cohort.
Purpose of the Study:
- To analyze the outcomes of various treatment modalities for urethral strictures in children.
- To compare the efficacy of different surgical approaches, including dilation, urethrotomy, and urethroplasty.
Main Methods:
- Retrospective review of 57 pediatric patients treated for urethral strictures over 12 years.
- Evaluation of treatment success rates for urethral dilation, direct vision urethrotomy, and one-stage versus multi-stage urethroplasty.
Main Results:
- Urethral dilation had limited success (28.6%), with better outcomes for inflammatory strictures compared to congenital or iatrogenic ones.
- Direct vision urethrotomy showed promise for iatrogenic bulbar strictures.
- One-stage urethroplasty demonstrated superior success rates compared to multi-stage procedures.
Conclusions:
- Pediatric urethral strictures necessitate tailored treatment strategies based on etiology.
- One-stage urethroplasty is a preferred approach for achieving successful long-term outcomes in pediatric urethral reconstruction.
Abstract:
During a 12-year period 57 children presented for treatment of urethral strictures. The patients ranged in age from 2 months to 18 years and there was 1 girl. Of the strictures 8 were congenital, 34 were iatrogenic, 4 were inflammatory and 11 were traumatic. Diagnosis can be suspected from the history and physical examination (observation of the voided stream), and confirmed radiographically and endoscopically. Urethral dilation was definitive treatment in only 28.6 per cent of the patients in whom it was used. Of 4 inflammatory strictures 2 responded to dilation as the only treatment, while only 1 of 5 congenital strictures and 1 of 5 iatrogenic strictures responded to dilation. Direct vision urethrotomy was successful in 1 of 2 congenital and in 5 of 5 iatrogenic bulbar strictures. A 1-stage urethroplasty seems preferable to multistaged procedures, since only 2 of 7 patients managed with staged procedures were treated successfully in 2 operations, while 5 of 9 treated with a 1-stage procedure have required no further intervention.