title: Long-term outcome of visual internal urethrotomy for the management of pediatric urethral strictures.
abstract: OBJECTIVE
  We evaluated the long-term results of visual internal urethrotomy for pediatric urethral strictures to evaluate the efficacy and final outcome of this procedure in children and to evaluate the risk factors for stricture recurrence.
  
  
  METHODS
  The computerized surgical records of our hospital were reviewed to identify children who underwent visual internal urethrotomy between 1980 and 2001. Hospital and followup clinical charts were then reviewed. Many variables were analyzed, including age, etiology, length and site of the strictures, and catheter duration. Only patients with a minimum followup of 2 years were included. Regular self-catheterization was not used by any child.
  
  
  RESULTS
  A total of 31 patients (mean age 11.2 years, range 2 to 18) were identified. Followup ranged from 2 to 20 years, with a mean of 6.6 years. The most common etiology for stricture formation was failed previous urethroplasty and post instrumentation (35.5% and 32.3%, respectively). The success rate after initial urethrotomy was 35.5% (11 of 31 patients). Mean interval to first recurrence was 26 months. A second urethrotomy improved the success rate of 58.1%. Eight patients required 2 or more urethrotomies, of whom half required open urethroplasty. Among the evaluated variables only stricture length shorter than 1 cm was associated with good results.
  
  
  CONCLUSIONS
  Visual internal urethrotomy provides a safe first line therapeutic option for pediatric urethral strictures shorter than 1 cm, independent of etiology and location. For patients with more than 1 recurrence or with strictures longer than 1 cm, who are at high risk for recurrence after internal urethrotomy, open urethroplasty remains the treatment of choice.
authors.affiliation: Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. athafez@yahoo.com
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Assmy
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Dawaba
authors.forename: Osama
authors.initials: O
authors.lastname: Sarhan
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Bazeed
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008297:Male; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*