Urethral strictures after fulguration of posterior urethral valves

This report discusses the incidence and predisposing factors for postfulguration urethral strictures in 82 boys with posterior urethral valves treated over 20 years and followed up for a period ranging from 1 to 21 years. A urethral stricture developed in three of the 82 patients (3.6%). All newborns and infants with small urethral caliber at presentation were treated on a temporary tubeless diversion, and fulguration of the valves was deferred until 9 to 12 months of age. A 9F resectoscope with a loop electrode was used to fulgurate at 5, 7, and 12 o'clock positions. A definite technical factor leading to a stricture could be identified in one of these three patients. Comparison of the "stricture" group with the "no stricture" group suggested that although dry fulguration did not have a definite correlation with stricture formation, it is best avoided. Refulguration and properly managed preoperative catheterization did not predispose to stricture formation. Meticulous surgical technique and avoiding oversized instrumentation were the most important factors for preventing this complication.