title: Direct vision internal urethrotomy for the treatment of pediatric urethral strictures: analysis of 50 patients.
abstract: OBJECTIVE
  In an attempt to evaluate our experience with the treatment of pediatric urethral stricture disease we performed a retrospective review of patients undergoing direct vision internal urethrotomy (DVIU).
  
  
  METHODS
  The computerized surgical logs at 2 pediatric hospitals were reviewed to identify patients who underwent DVIU between 1992 and 2001. Hospital and clinical charts were then reviewed. Many variables were analyzed, including patient age, etiology of stricture, technique and clinical outcomes. Minimum followup to be included in clinical outcome analysis was 12 months.
  
  
  RESULTS
  A total of 50 patients were identified (mean age 7.7 years, range 6 months to 17 years). The most common etiology for stricture formation was previous hypospadias repair (20 patients [40%]). Forty patients met the 12-month minimum followup requirement for clinical outcome analysis. Of these patients 20 (50%) had no symptoms to suggest recurrent stricture at a median of 2.0 years (mean 2.7 years, range 12 months to 7 years). Seventeen patients (42.5%) had symptoms of recurrent stricture at a median of 8 months (mean 13 months, range 2 months to 5 years). Technical factors did not influence the ultimate success or failure of the procedure.
  
  
  CONCLUSIONS
  DVIU provides a therapeutic option that successfully treats approximately half of the patients with a reasonably low complication rate. Complications following DVIU should not preclude its use as a therapeutic modality for the treatment urethral strictures in children. If the child fails the initial DVIU, repeat attempts at endoscopic correction of urethral stricture should be abandoned in favor of definitive urethroplasty.
authors.affiliation: Department of Urology, Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1901 Century Boulevard, Atlanta, GA, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Hsiao
authors.forename: Luis
authors.initials: L
authors.lastname: Baez-Trinidad
authors.forename: Thomas
authors.initials: T
authors.lastname: Lendvay
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Smith
authors.forename: Bruce
authors.initials: B
authors.lastname: Broecker
authors.forename: Hal
authors.initials: H
authors.lastname: Scherz
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000601:surgery; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*