Surgery For Bulbous Urethral Strictures In Boys - What Is The Optimal Surgical Strategy?

PURPOSE Optimal management of bulbous urethral strictures in children is poorly defined. We compared our long-term experience with direct vision internal urethrotomy (DVIU) and open repair with the objective of defining optimal surgical strategy. MATERIAL AND METHODS Sixty-three patients who had undergone DVIU or open repair were reviewed. Forty-six (73%) were treated with one or more DVIU's. Seventeen (27%) had urethroplasty, 13 end to end and 4 patch graft or tube. Eight of the 17 required urethroplasty only, whereas 9 had a combined approach of open and DVIU. Mean patient age was 14.1 years (range: 5 months to 21 years). Follow-up assessment entailed either VCUG, RUG, cystoscopy or flow rate or a combination. Mean follow-up was 30 months for those undergoing DVIU and 16 months for those having open urethroplasty. RESULTS When DVIU was the initial approach, one procedure was successful in 53% (28/53). Multiple DVIU's increased the success rate to 59% (43/73). Patients undergoing an initial DVIU required a mean of 1.6 procedures (84/53). When open repair was the initial approach one procedure was successful in 80% (8/10). This group required a mean of 1.2 procedures (12/10). A combined (DVIU/open) approach was successful in 78% (7/9). CONCLUSIONS Open reconstruction is more successful than DVIU as an initial approach to bulbous urethral strictures. Initial DVIU is successful in half. Repeat DVIU's add little to success. Success with a combined approach (DVIU/open) approximates that of initial open reconstruction. We advocate only one initial attempt DVIU followed by open urethroplasty, if necessary.