ICUD on Urethral StricturesSIU/ICUD Consultation on Urethral Strictures: Urethral Strictures in Children
Section snippets
Methods
A literature search was performed through PubMed for articles published from 1990 to 2010 on strictures in children. Thus, 508 articles were identified that were screened to select those that contained at least 10 patients ≤18 years of age. A total of 447 articles were eliminated because they were duplicate listings, review articles, expert opinion, or series of both adults and children. This left 32 articles, which provided the data for this review. The data included etiology of the stricture,
Meatal Strictures
There were between 18 and 100 patients in each of the 5 series that reported meatal strictures. The level of evidence of each of these articles was 3. Patient ages ranged from 20 months to 15 years. The etiology of the strictures was thought to primarily be diaper dermatitis in circumcised boys. A few were thought to be secondary to hypospadias repair or lichen sclerosus (LS). The presenting symptoms were decreased stream, prolonged voiding time, and deflected stream.
The treatments used
Comment
It is apparent from this review that the quality of the existing evidence to guide the management of urethral strictures in children is low, with the evidence consisting almost entirely of retrospective case series. Nevertheless, certain opinions have emerged from this review. Importantly, certain terms, specifically “success” and “stricture recurrence,” should be defined so that there can be uniformity of interpretation of results. A distinction should be made between an unsuccessful outcome
References (20)
- et al.
Evidence-based medicine overview of the main steps for developing and grading guideline recommendations
Prog Urol
(2007) - et al.
Functional evaluation of the results of hypospadias surgery with uroflowmetry
J Urol
(1995) - et al.
Open reconstruction of pediatric and adolescent urethral strictures: long-term followup
J Urol
(2003) - et al.
Guide wire-assisted urethral dilatation for urethral strictures in pediatric urology
J Pediatr Surg
(2003) - et al.
Treatment of pediatric urethral stricture disease with the neodymium:yttrium-aluminum-garnet laser
Urology
(1994) - et al.
Management of urethral strictures after hypospadias repair
J Urol
(1998) - et al.
Long-term outcome of visual internal urethrotomy for the management of pediatric urethral strictures
J Urol
(2005) - et al.
Direct vision internal urethrotomy for the treatment of pediatric urethral strictures: analysis of 50 patients
J Urol
(2003) - et al.
Stricture incidence related to suture material in hypospadias surgery
J Pediatr Surg
(1996) Posttraumatic posterior urethral strictures in children: a 20-year experience
J Urol
(1997)
Cited by (15)
Presentation, treatment and outcomes of pediatric anterior urethral strictures: 28 years’ experience from a referral center
2021, Journal of Pediatric UrologyCitation Excerpt :Stricture of the urethra is an uncommon problem in children, hence its management is not well defined and there is a paucity of literature upon which to base therapy, as the available evidence that does exist consists mostly of small case series. With exception of the collaborative 2014 Société Internationals d’Urologie (SIU) and International Consultation on Urological Diseases (ICUD) task force to generate evidence-based recommendations for those patients, there are literally no keystones that can be used for making evidence-based treatment decisions [24]. In a recent review on pediatric AUS, among 682 patients with AUS, stricture etiology was mostly iatrogenic (48%), followed by traumatic (34%), and congenital (13%) strictures.
Etiology and characteristics of pediatric urethral strictures in a developing country in the 21st century
2019, Journal of Pediatric UrologyCitation Excerpt :Urethral stricture disease has long been considered a disease of middle age, and although there are many large series on USD in adults, there is a dearth of information on pediatric strictures [2]. In 2014, when the Société Internationale d'Urologie (SIU) consensus committee reviewed the literature on pediatric urethral strictures for making their recommendations, a literature search performed through PubMed for articles published from 1990 to 2010 on strictures in children turned up only 32 articles that conformed to their criteria of containing at least 10 patients <18 years after excluding duplicate listings, review articles, expert opinion, or series of both adults and children [3]. It is no wonder that among them, studies focusing on stricture etiologies specifically are non-existent with most information reported only in relation to the description of various reconstructive techniques (see Fig. 1).
Urethroplasty for urethral injuries and trauma-related strictures in children and adolescents: a single-institution experience
2019, Journal of Pediatric UrologyCitation Excerpt :Urethroplasty to treat UITSs has more durable results compared with dilation or endoscopic procedures [7] but is technically more challenging. Nevertheless, successful urethroplasty is crucial to avoid life-long urinary complications such as recurrent stricture formation with subsequent lower urinary tract symptoms, urinary incontinence, and impotence [8]. Because of some anatomical differences in children, evidence obtained from adult urethroplasty cannot be transferred as such toward the pediatric population [9].
Penile fasciocutaneous flap urethroplasty for the reconstruction of pediatric long anterior urethral stricture
2018, Journal of Pediatric UrologyCitation Excerpt :Most urethral strictures in children are traumatic in origin; literally, about two-thirds of the pediatric urethral strictures are iatrogenic and affect the anterior urethra [4]. Strictures of the anterior urethra in pediatrics might be idiopathic in origin (perchance congenital), inflammatory, or post-hypospadias repair [5]. The treatment options of pediatric anterior urethral stricture repair include laser urethrotomy with a success rate of 84%, visual optic internal urethrotomy with 35%–58% success rate, excision and end to end anastomosis with a success rate of 100% when it is anatomically feasible, skin flap, or buccal mucosa graft (BMG) with 87%–100% success rate [6–10].
Financial Disclosure: The authors declare that they have no relevant financial interests.