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Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife

  • Urology - Original Paper
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Abstract

Purpose

To compare efficacy and safety of visual internal urethrotomy (VIU) using holmium laser (Ho:YAG) (group A) versus cold knife (group B) in children with urethral strictures. It may be the first comparative study on this issue in children.

Methods

This study compared Ho:YAG group, which was evaluated prospectively from January 2014 till January 2016, versus cold knife group, which was a historical control performed from March 2008 till February 2010. Children ≤ 13 years old with urethral strictures ≤ 1.5 cm were included successively. Recurrent cases, congenital obstructions and cases with complete arrest of dye in voiding cystourethrography were excluded. Scar tissue was incised at twelve o’clock. Outcome was compared using Student’s t, Mann–Whitney, Chi-square or Fisher exact tests as appropriate.

Results

Each group included 21 patients. Mean age was 6.27 ± 3.23 (2–13) years old. Mean stricture length was 1.02 versus 1 cm in group A versus B, respectively (p = 0.862). Ten cases of penile/bulbous strictures and another 11 cases of membranous strictures were found in each group. There was no significant difference between both groups in preoperative data. Success rate for initial VIU was 66.7% in group A versus 38% in group B (p = 0.064). This was associated with significantly higher Qmax in group A (mean 16.52 vs 12.09 ml/s; p = 0.03). Success rate after two trials of VIU was 76.2% for group A and 47.61% for group B (p = 0.057). No complications were reported in both groups.

Conclusion

Laser VIU has a higher success rate than cold knife VIU for urethral strictures ≤ 1.5 cm in children with significantly higher Qmax. Both are easy to perform, low invasive and safe.

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Abbreviations

VIU:

Visual internal urethrotomy

Ho:YAG:

Holmium laser

VCUG:

Voiding cystourethrography

References

  1. Das S (2007) Urology in ancient India. Indian J Urol 23:2–5

    Article  PubMed  PubMed Central  Google Scholar 

  2. Peterson AC, Webster GD (2004) Management of urethral stricture disease: developing options for surgical intervention. BJU Int 94:971–976

    Article  PubMed  Google Scholar 

  3. Gibbons MD, Koontz WW, Smith MJV (1979) Urethral strictures in boys. J Urol 121(2):217–220

    Article  CAS  PubMed  Google Scholar 

  4. Shoukry AI, Abouela WN, ElSheemy MS, Shouman AM, Daw K, Hussein AA, Morsi H, Mohsen MA, Badawy H, Eissa M (2016) Use of holmium laser for urethral strictures in pediatrics: a prospective study. J Pediatr Urol 12(1):42.e1–6. https://doi.org/10.1016/j.jpurol.2015.06.016

    Article  PubMed  Google Scholar 

  5. Futao S, Wentong Z, Yan Z, Qingyu D, Aiwu L (2006) Application of endoscopic Ho:YAG laser incision technique treating urethral strictures and urethral atresias in pediatric patients. Pediatr Surg Int 22(6):514–518 (Epub 2006 Apr 29)

    Article  PubMed  Google Scholar 

  6. Launonen E, Sairanen J, Ruutu M, Taskinen S (2014) Role of visual internal urethrotomy in pediatric urethral strictures. J Pediatr Urol 10(3):545–549. https://doi.org/10.1016/j.jpurol.2013.11.018

    Article  PubMed  Google Scholar 

  7. Hafez AT, El-Assmy A, Dawaba MS, Sarhan O, Bazeed M (2005) Long-term outcome of visual internal urethrotomy for the management of pediatric urethral strictures. J Urol 173(2):595–597

    Article  PubMed  Google Scholar 

  8. Diamond DA, Xuewu J, Bauer SB, Cilento BG Jr, Borer JG, Nguyen H et al (2009) What is the optimal surgical strategy for bulbous urethral stricture in boys? J Urol 182:1755–1758

    Article  PubMed  Google Scholar 

  9. Dushinski JW, Lingeman JE (1997) Urologic applications of the Holmium laser. Tech Urol 3(2):60–64

    CAS  PubMed  Google Scholar 

  10. Barbagli G, Palminteri E, Lazzeri M, Guazzoni G, Turini D (2001) Long-term outcome of urethroplasty after failed urethrotomy versus primary repair. J Urol 165:1918–1919

    Article  CAS  PubMed  Google Scholar 

  11. Bullock TL, Brandes SB (2007) Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J Urol 177:685–690

    Article  PubMed  Google Scholar 

  12. Buckley JC, Heyns C, Gilling P, Carney J (2014) SIU/ICUD consultation on urethral strictures: dilation, internal urethrotomy, and stenting of male anterior urethral strictures. Urology 83(3 suppl):S18–S22

    Article  PubMed  Google Scholar 

  13. Ogbonna BC (1998) Managing many patients with a urethral stricture: a cost-benefit analysis of treatment options. Br J Urol 81:741–744

    Article  CAS  PubMed  Google Scholar 

  14. Greenwell TJ, Castle C, Andrich DE, MacDonald JT, Nicol DL, Mundy AR (2004) Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective. J Urol 172:275–277

    Article  CAS  PubMed  Google Scholar 

  15. Hsiao KC, Baez-Trinidad L, Lendvay T, Smith EA, Broecker B, Scherz H, Kirsch AJ (2003) Direct vision internal urethrotomy for the treatment of pediatric urethral strictures: analysis of 50 patients. J Urol 170(3):952–955

    Article  PubMed  Google Scholar 

  16. Singla M, Jha MS, Muruganandam K, Srivastava A, Ansari MS, Mandhani A, Dubey D, Kapoor R (2008) Posttraumatic posterior urethral strictures in children—management and intermediate-termfollow-up in tertiary care center. Urology 72(3):540–543. https://doi.org/10.1016/j.urology.2008.02.078 (discussion 543–4. Epub 2008 Jul 10)

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Urology, Aboul-Riche Children’s Hospital, Cairo University, Cairo, Egypt

    Waseem Aboulela, Mohammed S. ElSheemy, Ahmed M. Shouman, Ahmed I. Shoukry, Waleed Ghoneima, Mohamed El Ghoneimy, Hany A. Morsi, Mostafa Abdel Mohsen & Hesham Badawy

  2. Urology Department, Fayoum University, Fayoum, Egypt

    Mahmoud Shoukry

  3. Urology Department, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt

    Mohammed S. ElSheemy

Authors
  1. Waseem Aboulela
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  2. Mohammed S. ElSheemy
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  3. Mahmoud Shoukry
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  4. Ahmed M. Shouman
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  5. Ahmed I. Shoukry
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  6. Waleed Ghoneima
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  7. Mohamed El Ghoneimy
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  8. Hany A. Morsi
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  9. Mostafa Abdel Mohsen
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  10. Hesham Badawy
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Corresponding author

Correspondence to Mohammed S. ElSheemy.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was in accordance with the ethical standards of the local ethical committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from parents of all children included in the study.

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Aboulela, W., ElSheemy, M.S., Shoukry, M. et al. Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife. Int Urol Nephrol 50, 605–609 (2018). https://doi.org/10.1007/s11255-018-1809-x

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  • DOI: https://doi.org/10.1007/s11255-018-1809-x

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