Banks F C L, Griffin S J, Steinbrecher H A, Malone P S
Department of Paediatric Urology, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, UK.
J Pediatr Urol. 2009 Jun;5(3):215-8; discussion 219-20. doi: 10.1016/j.jpurol.2009.01.004. Epub 2009 Feb 20.
To report the presentation and treatment outcomes on a series of 12 paediatric bulbar or posterior urethral strictures that were possibly congenital in origin, identified in a 9-year period.
A retrospective case-note review of all cases of urethral strictures thought to be congenital in origin, prospectively collected into the departmental database.
The age at presentation had a bimodal distribution with 6/12 presenting in the first year of life of which four had antenatal hydronephrosis and 5/12 presenting after the age of 11 years. All six patients under 1-year old had a successful outcome following urethrotomy and urethral dilatation. Four of five over 11 years of age ultimately required an urethroplasty and one 3-year-old may well require an urethroplasty in the future.
This outcome, in conjunction with the bimodal age distribution at presentation, would suggest a different aetiology in older children, and we would urge caution in classifying strictures in ambulant children as genuinely congenital, as this population may represent the long-term manifestation of unrecorded bulbar urethral trauma or asymptomatic inflammation. Optical urethrotomy or dilatation is durable when treated in infancy, but older patients do not experience prolonged resolution and we would recommend treatment along adult lines for these.
报告在9年期间发现的一系列12例可能为先天性起源的小儿球部或后尿道狭窄的临床表现及治疗结果。
对所有被认为是先天性起源的尿道狭窄病例进行回顾性病例笔记审查，这些病例已前瞻性收集到科室数据库中。
就诊年龄呈双峰分布，12例中有6例在出生后第一年就诊，其中4例有产前肾积水，5例在11岁以后就诊。所有6例1岁以下的患者在尿道切开术和尿道扩张术后均取得了成功的结果。5例11岁以上的患者中有4例最终需要进行尿道成形术，1例3岁的患者将来很可能也需要进行尿道成形术。
这一结果，结合就诊时的双峰年龄分布，提示大龄儿童的病因不同，我们敦促在将行走儿童的尿道狭窄归类为真正先天性狭窄时要谨慎，因为这一群体可能代表未记录的球部尿道创伤或无症状炎症的长期表现。婴儿期接受光学尿道切开术或扩张术治疗效果持久，但大龄患者的病情缓解时间不长，我们建议对这些患者采用成人治疗方案。
