Herle Koushik, Jehangir Susan, Thomas Reju J
Department of Pediatric Surgery and Paediatric Urology, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
J Indian Assoc Pediatr Surg. 2018 Oct-Dec;23(4):192-197. doi: 10.4103/jiaps.JIAPS_146_17.
Pediatric urethral stricture and its treatment have functional implications in the growing child.
A retrospective study of records on urethral strictures encountered in our institution between January 2005 and May 2016 yielded 23 boys against a backdrop of 19,250 admissions during the same period; stenosis and strictures after hypospadias repair were not included in this study. Demographic data were collected from the charts, and the success of repair was assessed clinically by success of repair was assessed clinically by observing for presence or absence of symptoms such as dribbling, straining at voiding, adequacy of urinary stream and radiologicaly by assessing the micturition phase of voiding cystourethrogram. Success was defined as successful initiation, flow, and completion of voiding with radiological evidence of reestablishment of urethral continuity.
The most common cause of urethral stricture was perineal or pelvic trauma (56.5%). Three after surgery for anorectal malformation (13.04%) and 2 (8.6%) followed otherwise unspecified urethritis. Transperineal and transpubic anastomotic routes were used for surgery. Redo surgery was required in 47.8%. The overall success rate was 82%. A self-catheterizable mitrofanoff channel was created as part of the primary procedure in 63.6% (7/11) or after the failure of the first procedure in 36.3% (4/11).
The majority of urethral strictures are long-segment strictures or those with complete disruption not amenable to endoscopic techniques. The aim of the surgery is to obtain end-to-end opposition of healthy proximal and distal urethra. The route - transperineal or transpubic - which will give the best access to the ends of the urethra is determined by the location and extent of the stricture and the alteration in anatomy as a consequence of the pelvic fracture. Even after the introduction of laser and endoscopic techniques, surgical repair is required to tackle the majority of urethral strictures in children.
小儿尿道狭窄及其治疗对成长中的儿童具有功能方面的影响。
对2005年1月至2016年5月间在本机构遇到的尿道狭窄病例记录进行回顾性研究，在同期19250例住院病例中发现23例男孩；本研究不包括尿道下裂修复术后的狭窄和闭锁。从病历中收集人口统计学数据，并通过观察是否存在诸如滴沥、排尿费力、尿流是否通畅等症状进行临床评估修复的成功率，以及通过评估排尿期膀胱尿道造影来进行影像学评估。成功定义为排尿开始、排尿过程及排尿结束顺利，并有尿道连续性重建的影像学证据。
尿道狭窄最常见的原因是会阴或骨盆创伤（56.5%）。3例（13.04%）发生于肛门直肠畸形手术后，2例（8.6%）继发于未明确的尿道炎。手术采用经会阴和经耻骨吻合途径。47.8%的患者需要再次手术。总体成功率为82%。63.6%（7/11）的患者在初次手术时创建了可自行导尿的米氏通道，36.3%（4/11）的患者在初次手术失败后创建。
大多数尿道狭窄为长段狭窄或完全断裂，不适合内镜技术治疗。手术的目的是使健康的近端和远端尿道端端对合。经会阴或经耻骨途径能最佳地显露尿道两端，这取决于狭窄的位置和范围以及骨盆骨折导致的解剖结构改变。即使引入了激光和内镜技术，仍需手术修复来处理大多数小儿尿道狭窄。
