Complications and management of childhood urethral stricture disease.

In many ways, the management of urethral stricture disease in children parallels that in adults, but striking differences exist. The technical demands made because of the small size of the strictures and the delicacy of the tissues involved certainly provide more of a challenge. Newer instrumentation, improved techniques, and increased experience in children are helping us to meet these challenges. Visual urethrotomy should be considered the initial treatment of choice for anterior urethral strictures, and urethroplasty should be reserved for treatment failures. Attention to technical detail and proper patient preparation will ensure optimum results from urethroplasty. Posterior urethral strictures as a result of pelvic injury can be influenced by proper initial management but remain an open surgical disease of considerable challenge. The fact that in children a large proportion of urethral stricture disease is iatrogenic provides us with a real opportunity for prevention. As with any disease state, prevention or minimization of complications of treatment is the ultimate goal. It is only through a careful, thoughtful approach that we can begin to achieve that end.