Traumatic Obliterative Urethral Strictures in Pediatric Patients: Failure of the Cut to Light Technique at Long-Term Followup

Matthew K. Tollefson, Richard A. Ashley, Jonathan C. Routh, Douglas A. Husmann

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: The cut to light procedure or antegrade and retrograde urethroscopy with endoscopic incision of obliterative urethral strictures is an accepted method of treating posterior urethral distraction injuries. We report long-term followup on 22 pediatric patients treated with this technique. Materials and Methods: The records of all pediatric patients with a posterior urethral distraction injury treated from 1986 through 2006 were reviewed. The cut to light procedure was performed for obliterative strictures less than 1 cm via a cold knife or laser in 11 patients each. A urethral catheter was left in situ for 3 weeks. Patients were then followed a minimum of 2 years. Results: A total of 22 patients at a median age of 11 years (range 3 to 16) were treated. Followup revealed stricture recurrence in all patients. Median time to recurrence was 3 months after catheter removal (range 5 days to 1 year). Although intermittent catheterization to maintain patency was attempted in all patients, the development of impassable urethral strictures in 16 (73%) and complaints of chronic pain with catheterization in 4 (18%) led to end-to-end urethroplasty. Successful reconstruction with open surgery was achieved in 19 of 20 patients (95%). Two patients (9%) maintained urethral patency with intermittent catheterization. Conclusions: In children with obliterative posterior urethral distraction injuries a cut to light procedure had a long-term success rate of 0%. All patients required daily intermittent catheterization (9%) or formal urethral reconstruction (91%) to maintain patency. We would strongly recommend against treating pediatric obliterative urethral strictures with a cut to light procedure.

Original languageEnglish (US)
Pages (from-to)1656-1658
Number of pages3
JournalJournal of Urology
Volume178
Issue number4 SUPPLEMENT
DOIs
StatePublished - Oct 2007

Fingerprint

Urethral Stricture
Pediatrics
Light
Catheterization
Wounds and Injuries
Pathologic Constriction
Recurrence
Urinary Catheters
Laser Therapy
Chronic Pain
Catheters

Keywords

  • endoscopy
  • pelvis
  • reconstructive surgical procedures
  • urethral stricture
  • wounds and injuries

ASJC Scopus subject areas

  • Urology

Cite this

Traumatic Obliterative Urethral Strictures in Pediatric Patients : Failure of the Cut to Light Technique at Long-Term Followup. / Tollefson, Matthew K.; Ashley, Richard A.; Routh, Jonathan C.; Husmann, Douglas A.

In: Journal of Urology, Vol. 178, No. 4 SUPPLEMENT, 10.2007, p. 1656-1658.

Research output: Contribution to journalArticle

Tollefson, Matthew K. ; Ashley, Richard A. ; Routh, Jonathan C. ; Husmann, Douglas A. / Traumatic Obliterative Urethral Strictures in Pediatric Patients : Failure of the Cut to Light Technique at Long-Term Followup. In: Journal of Urology. 2007 ; Vol. 178, No. 4 SUPPLEMENT. pp. 1656-1658.
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abstract = "Purpose: The cut to light procedure or antegrade and retrograde urethroscopy with endoscopic incision of obliterative urethral strictures is an accepted method of treating posterior urethral distraction injuries. We report long-term followup on 22 pediatric patients treated with this technique. Materials and Methods: The records of all pediatric patients with a posterior urethral distraction injury treated from 1986 through 2006 were reviewed. The cut to light procedure was performed for obliterative strictures less than 1 cm via a cold knife or laser in 11 patients each. A urethral catheter was left in situ for 3 weeks. Patients were then followed a minimum of 2 years. Results: A total of 22 patients at a median age of 11 years (range 3 to 16) were treated. Followup revealed stricture recurrence in all patients. Median time to recurrence was 3 months after catheter removal (range 5 days to 1 year). Although intermittent catheterization to maintain patency was attempted in all patients, the development of impassable urethral strictures in 16 (73{\%}) and complaints of chronic pain with catheterization in 4 (18{\%}) led to end-to-end urethroplasty. Successful reconstruction with open surgery was achieved in 19 of 20 patients (95{\%}). Two patients (9{\%}) maintained urethral patency with intermittent catheterization. Conclusions: In children with obliterative posterior urethral distraction injuries a cut to light procedure had a long-term success rate of 0{\%}. All patients required daily intermittent catheterization (9{\%}) or formal urethral reconstruction (91{\%}) to maintain patency. We would strongly recommend against treating pediatric obliterative urethral strictures with a cut to light procedure.",
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