Etiology and characteristics of pediatric urethral strictures in a developing country in the 21st century. Issue 4 (August 2019)

• Record Type: Journal Article
• Authors: Ansari, M.S.; Yadav, P.; Srivastava, A.; Kapoor, R.; Ashwin Shekar, P.
• Is Part Of: Journal of pediatric urology. Volume 15:Issue 4(2019)
• Page Start: 403.e1
• Page End: 403.e8
• Publication Date: 2019-08
• Subjects: Stricture -- Urethra -- Pediatric -- Etiology; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2019.05.020
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Background: Urethral stricture disease in children is not uncommon as assumed; however, most of the information about the etiology, features, and natural history of pediatric strictures is extrapolations from adult series as the literature on this common entity is sparse, and most of the studies are small series. Objective: The current etiology and clinical features of urethral stricture disease in the pediatric population in the developing world were determined. Materials and methods: The data of children with urethral stricture disease, who had undergone treatment in the tertiary center from 2001 to 2017, were retrospectively analyzed. After excluding girls, the database was analyzed for clinical presentation, possible causes of stricture, site and number of strictures, and length of stricture and for previous interventions. Subanalysis was performed for stricture etiology by patient age, stricture length, site, previous treatments, and presentation with paraurethral abscess. Results: A total of 195 boys with strictures were identified. The common causes of pediatric urethral stricture were traumatic (36.9%), iatrogenic (31.8%), and idiopathic (28.7%). The anterior urethra was the location of the stricture in 141 patients (72.3%). Iatrogenic causes (due to catheterization, hypospadias repair, and valve fulguration) accounted for the majority of anterior urethral strictures (61/141 or 43.2%). Younger children had a tendency to have an iatrogenic and idiopathic cause for strictures, whereas older children had a traumatic etiology; 18.6% of strictures in children younger than 10 years were secondary to trauma, whereas 44.9% of the strictures in patients older than 10 years were traumatic in origin. Trauma was the major cause of posterior urethral strictures (53/54 or 98.1%) and was always associated with pelvic fracture. Strictures due to lichen sclerosus or infectious cause were rare (5 patients or 2.6%). The length of strictures was longer in pan anterior urethral strictures (mean: 82.0 mm) than that of those due to lichen sclerosus (mean: 42.5 mm) and in patients who had undergone previous treatment (mean: 28.7 mm). Conclusion: Iatrogenic causes such as catheterization and hypospadias repair account for the majority of anterior urethral stricture disease in the pediatric population, especially the younger age-group. However, as the child grows, there is a gradual preponderance of traumatic urethral strictures, including posterior urethral strictures. Table1 Pediatric urethral stricture characteristics. Table1 Variable Site Total Meatus Penile Bulbar Multifocal Pan anterior Posterior Mean length (mm) 5.9 ± 3.9 20.1 ± 14.9 12.4 ± 9.0 45.3 ± 27.1 82.0 ± 19.2 29.4 ± 14.9 21.3 ± 20.2 Mean age (yrs) 8.6 ± 5.1 11.3 ± 5.8 12.9 ± 5.3 11.4 ± 5.7 17.0 ± 2.2 13.9 ± 4.1 12.5 ± 5.2 Etiology, n (%) Idiopathic 11 02 39 04 0 0 56 (28.7%) Iatrogenic 09 21 15 12 04 01 62 (31.8%) Catheterization 01 02 08 09 04 0 24 (12.3%) Endoscopy 02 01 01 0 0 0 04 (2.1%) Valve fulguration 01 01 06 02 0 01 11 (5.6%) Hypospadias repair 05 15 0 01 0 0 21 (10.8%) Others 0 02 0 0 0 0 02 (1.0%) Lichen sclerosus 02 01 0 0 01 0 4 (2.1%) Inflammatory 0 0 01 0 0 0 1 (0.5%) Traumatic 0 0 18 01 0 53 72 (36.9%) Total 22 (11.3) 24 (12.3) 73 (37.4) 17 (8.7) 5 (2.6) 54 (27.7) 195