Transurethral resection in children with urethral stricture and occlusion

Technical considerations of urethral surgery in children are critical because of the small size and delicacy of the urethra. From 1984 to 1989, children ages 4 to 14 years with serious traumatic urethral strictures (n = 5) or occlusion (n = 5) were treated. For anterior lesions, transurethral resection (TUR) with a Storz urethroresectoscope (10F-15F) was used to excise all scar tissue after the stenotic tract had been incised or dilated. For lesions in the posterior urethra, the bladder was opened or the cystostomy tract dilated, allowing the operator's index finger to be passed to the posterior end of the lesion while an assistant's finger was inserted into the patient's rectum. A sharp-tip 4F sound was then guided up the urethra into the bladder, the lesion was dilated, and the scar tissue was excised. With an average of 24.4 months of follow-up, success was achieved in all patients, requiring one session in seven patients and two or three sessions in the others. Recurrences in three patients were cured by repeat TUR. There were three cases of epididymitis and two of scrotal edema. This procedure is recommended as the treatment of choice for children with urethral strictures or occlusions. Thorough clearance of scar tissue is valuable to enhance the cure rate.