Stricture urethra in children: An Indian perspective

Abstract

Background:Pediatric urethral stricture and its treatment have functional implications in the growing child.Subjects and Methods:A retrospective study of records on urethral strictures encountered in our institution between January 2005 and May 2016 yielded 23 boys against a backdrop of 19,250 admissions during the same period; stenosis and strictures after hypospadias repair were not included in this study. Demographic data were collected from the charts, and the success of repair was assessed clinically by success of repair was assessed clinically by observing for presence or absence of symptoms such as dribbling, straining at voiding, adequacy of urinary stream and radiologicaly by assessing the micturition phase of voiding cystourethrogram. Success was defined as successful initiation, flow, and completion of voiding with radiological evidence of reestablishment of urethral continuity.Results:The most common cause of urethral stricture was perineal or pelvic trauma (56.5%). Three after surgery for anorectal malformation (13.04%) and 2 (8.6%) followed otherwise unspecified urethritis. Transperineal and transpubic anastomotic routes were used for surgery. Redo surgery was required in 47.8%. The overall success rate was 82%. A self-catheterizable mitrofanoff channel was created as part of the primary procedure in 63.6% (7/11) or after the failure of the first procedure in 36.3% (4/11).Conclusion:The majority of urethral strictures are long-segment strictures or those with complete disruption not amenable to endoscopic techniques. The aim of the surgery is to obtain end-to-end opposition of healthy proximal and distal urethra. The route – transperineal or transpubic – which will give the best access to the ends of the urethra is determined by the location and extent of the stricture and the alteration in anatomy as a consequence of the pelvic fracture. Even after the introduction of laser and endoscopic techniques, surgical repair is required to tackle the majority of urethral strictures in children.

A Retrospective Survey of Pediatric Urethral Stricture in Isfahan, Iran

“…2019; 10(4):e88802. in agreement with previous studies, the number of the boys with urethral strictures was 9.9 times higher than the number of the girls (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In this population study, 86.2% of surgical treatments for urethral strictures in children were at the age between 1 to 10 years old.…”

“…The challenging conditions urethral stricture in children is a common disease (12) that surgery is recommended as the basis of management in most cases (1). Data about the etiology and clinical history of urethral stricture in children are extrapolated from adult series, and practical facts about this object seem scarce (12).…”

“…Owing to a longer urethra in boys, urethral strictures are much more common than in girls. Traumatic and inflammatory strictures are rare, but it can be caused by congenital, infection, inflammation and traumatic sources' (1)(2)(3). Acquired types of urethral strictures are basically different from the congenital strictures (4).…”

“…Recent progression in pediatric reconstructive surgery has led to a few innovative aggressive procedures that are suggested as remarkable methods of treatment for urethral strictures. Primary repair that is performed transperinealy is now a generally accepted method of choice for pediatric urethral stricture repair (1). In 47% of boys with urethral strictures, dilation or urethrotomy have been reported unsuccessful with recurrence associated with new strictures on both occasions.…”

Outcome of Delayed Perineal Anastomotic Urethroplasty in Children with Post-Traumatic Urethral Stricture in a Tertiary Center, Addis Ababa, Ethiopia

“…The actual length that determines tension on anastomosis is the one measured after excision of all scar tissue and refreshing the ends of both the proximal and distal urethra, however, as the gap described by different authors is not this final one, there may be over- or underestimation. 16 , 24 …”