Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience

Aim:Most of the surgical strategies for pediatric urethral strictures (PUS) are derived from adult experiences. Owing to this, we carried out this study to assess the management strategies for PUS in our institute.Materials and Methods:This prospective study included 28 patients with PUS. Preoperati...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Mir Fahiem-ul-Hassan, Vinay Jadhav, Narendrababu Munianjanappa, Murali Saroja
Formato:	article
Lenguaje:	EN TR
Publicado:	Galenos Yayinevi 2021
Materias:	pediatric urethral strictures urethral dilatation direct visualisation and internal urethrotomy excision and primary anastomosis Medicine R Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/d749de66343646fca9994c130dd4d625
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:d749de66343646fca9994c130dd4d625
record_format	dspace
spelling	oai:doaj.org-article:d749de66343646fca9994c130dd4d6252021-11-11T11:27:23ZPediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience2147-94452587-247810.4274/jpr.galenos.2021.83604https://doaj.org/article/d749de66343646fca9994c130dd4d6252021-12-01T00:00:00Z http://jpedres.org/archives/archive-detail/article-preview/pediatric-urethral-strictures-and-management-strat/49642 https://doaj.org/toc/2147-9445https://doaj.org/toc/2587-2478Aim:Most of the surgical strategies for pediatric urethral strictures (PUS) are derived from adult experiences. Owing to this, we carried out this study to assess the management strategies for PUS in our institute.Materials and Methods:This prospective study included 28 patients with PUS. Preoperatively, patients were assessed clinically and were subjected to voiding cystourethrography (VCUG) and pre-procedure cystoscopy. Intraoperatively, urethroscopy, VCUG and retrograde urethrography were used to evaluate the length of the stricture. Urethral dilatation (UD), direct visualization and internal urethrotomy (DVIU), excision and primary anastomosis (EPA) with or without pubectomy and dorsal onlay urethroplasty (DOU) were the procedures instituted to treat the strictures. After the procedure, a silicone catheter was left in situ for 1-2 weeks in cases of DU or DVIU and 4-6 weeks in cases of EPA or DOU. Postoperatively, patients were assessed in terms of their symptoms and for VCUG/cystoscopic evidence of reestablishment of urethral continuity. There was an average follow-up period of 1.9 years.Results:Three patients were successfully treated with single session UD and another three with multiple sessions. Two UD patients required EPA. DVIU was performed in four patients. This procedure failed in one and so required EPA. EPA was carried out in fourteen patients with two requiring redo-EPA. Graft onlay urethroplasty was performed in five patients with satisfactory results.Conclusion:The procedure to address a stricture should be tailored to the individual urethral anatomy, stricture length and the surgeons’ experience. For smaller and partially obstructing strictures, DVIU and DU can be tried but these procedures seem to be less effective than EPA, with high rates of secondary procedures. However, if not accompanied by complete excision of fibrosed spongiosum, EPA may have to be repeated. For longer bulbar strictures, substitution urethroplasties are viable alternatives.Mir Fahiem-ul-HassanVinay JadhavNarendrababu MunianjanappaMurali SarojaGalenos Yayineviarticlepediatric urethral stricturesurethral dilatationdirect visualisation and internal urethrotomyexcision and primary anastomosisMedicineRPediatricsRJ1-570ENTRJournal of Pediatric Research, Vol 8, Iss 4, Pp 444-450 (2021)
institution	DOAJ
collection	DOAJ
language	EN TR
topic	pediatric urethral strictures urethral dilatation direct visualisation and internal urethrotomy excision and primary anastomosis Medicine R Pediatrics RJ1-570
spellingShingle	pediatric urethral strictures urethral dilatation direct visualisation and internal urethrotomy excision and primary anastomosis Medicine R Pediatrics RJ1-570 Mir Fahiem-ul-Hassan Vinay Jadhav Narendrababu Munianjanappa Murali Saroja Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience
description	Aim:Most of the surgical strategies for pediatric urethral strictures (PUS) are derived from adult experiences. Owing to this, we carried out this study to assess the management strategies for PUS in our institute.Materials and Methods:This prospective study included 28 patients with PUS. Preoperatively, patients were assessed clinically and were subjected to voiding cystourethrography (VCUG) and pre-procedure cystoscopy. Intraoperatively, urethroscopy, VCUG and retrograde urethrography were used to evaluate the length of the stricture. Urethral dilatation (UD), direct visualization and internal urethrotomy (DVIU), excision and primary anastomosis (EPA) with or without pubectomy and dorsal onlay urethroplasty (DOU) were the procedures instituted to treat the strictures. After the procedure, a silicone catheter was left in situ for 1-2 weeks in cases of DU or DVIU and 4-6 weeks in cases of EPA or DOU. Postoperatively, patients were assessed in terms of their symptoms and for VCUG/cystoscopic evidence of reestablishment of urethral continuity. There was an average follow-up period of 1.9 years.Results:Three patients were successfully treated with single session UD and another three with multiple sessions. Two UD patients required EPA. DVIU was performed in four patients. This procedure failed in one and so required EPA. EPA was carried out in fourteen patients with two requiring redo-EPA. Graft onlay urethroplasty was performed in five patients with satisfactory results.Conclusion:The procedure to address a stricture should be tailored to the individual urethral anatomy, stricture length and the surgeons’ experience. For smaller and partially obstructing strictures, DVIU and DU can be tried but these procedures seem to be less effective than EPA, with high rates of secondary procedures. However, if not accompanied by complete excision of fibrosed spongiosum, EPA may have to be repeated. For longer bulbar strictures, substitution urethroplasties are viable alternatives.
format	article
author	Mir Fahiem-ul-Hassan Vinay Jadhav Narendrababu Munianjanappa Murali Saroja
author_facet	Mir Fahiem-ul-Hassan Vinay Jadhav Narendrababu Munianjanappa Murali Saroja
author_sort	Mir Fahiem-ul-Hassan
title	Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience
title_short	Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience
title_full	Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience
title_fullStr	Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience
title_full_unstemmed	Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience
title_sort	pediatric urethral strictures and management strategies; an evolving and learning experience
publisher	Galenos Yayinevi
publishDate	2021
url	https://doaj.org/article/d749de66343646fca9994c130dd4d625
work_keys_str_mv	AT mirfahiemulhassan pediatricurethralstricturesandmanagementstrategiesanevolvingandlearningexperience AT vinayjadhav pediatricurethralstricturesandmanagementstrategiesanevolvingandlearningexperience AT narendrababumunianjanappa pediatricurethralstricturesandmanagementstrategiesanevolvingandlearningexperience AT muralisaroja pediatricurethralstricturesandmanagementstrategiesanevolvingandlearningexperience
_version_	1718439171787325440

Pediatric Urethral Strictures and Management Strategies; An Evolving and Learning Experience

Ejemplares similares