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J Urol. 2007 Oct;178(4 Pt 2):1656-8; discussion 1658. Epub 2007 Aug 17.

Traumatic obliterative urethral strictures in pediatric patients: failure of the cut to light technique at long-term followup.

Author information

1
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.

Abstract

PURPOSE:

The cut to light procedure or antegrade and retrograde urethroscopy with endoscopic incision of obliterative urethral strictures is an accepted method of treating posterior urethral distraction injuries. We report long-term followup on 22 pediatric patients treated with this technique.

MATERIALS AND METHODS:

The records of all pediatric patients with a posterior urethral distraction injury treated from 1986 through 2006 were reviewed. The cut to light procedure was performed for obliterative strictures less than 1 cm via a cold knife or laser in 11 patients each. A urethral catheter was left in situ for 3 weeks. Patients were then followed a minimum of 2 years.

RESULTS:

A total of 22 patients at a median age of 11 years (range 3 to 16) were treated. Followup revealed stricture recurrence in all patients. Median time to recurrence was 3 months after catheter removal (range 5 days to 1 year). Although intermittent catheterization to maintain patency was attempted in all patients, the development of impassable urethral strictures in 16 (73%) and complaints of chronic pain with catheterization in 4 (18%) led to end-to-end urethroplasty. Successful reconstruction with open surgery was achieved in 19 of 20 patients (95%). Two patients (9%) maintained urethral patency with intermittent catheterization.

CONCLUSIONS:

In children with obliterative posterior urethral distraction injuries a cut to light procedure had a long-term success rate of 0%. All patients required daily intermittent catheterization (9%) or formal urethral reconstruction (91%) to maintain patency. We would strongly recommend against treating pediatric obliterative urethral strictures with a cut to light procedure.

PMID:
17707030
DOI:
10.1016/j.juro.2007.03.182
[Indexed for MEDLINE]

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