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|Year : 2014 | Volume
| Issue : 1 | Page : 86-87
Post ablation urethral stricture in posterior urethral valve
A Singh, M Bajpai, K Chand, A Ali
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||14-Mar-2014|
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh A, Bajpai M, Chand K, Ali A. Post ablation urethral stricture in posterior urethral valve. J Postgrad Med 2014;60:86-7
| :: Introduction|| |
Universally accepted treatment protocol for managing posterior urethral vale (PUV) includes cystoscopic valve ablation using cold knife or electrocautery or LASER. We present here our experience of two cases that presented with stricture urethra post ablation and were managed successfully.
| :: Case Reports|| |
A 13 month-old boy, a follow up case of type 1 posterior urethral valve (PUV) underwent cystoscopic valve ablation at day 2 of life. For the last 2 months, the parents noticed poor urinary stream and straining during micturition. Micturating cystourethrogram (MCU) and retrograde urethrography (RGU) showed a stricture at bulbomembranous junction and no residual valve. The child underwent resection of strictured segment and end-to-end anastamosis via preanal anterior coronal described previously by us for managing posterior urethral strictures  [Figure 1]. The postoperative period was uneventful and the child recovered well. At the 6 month follow-up, the child was doing well without any urinary complaints.
A 4 year-old boy, a follow up case of type 3 PUV underwent cystoscopic valve incision with cold knife at a year of age. Two years post incision, the child developed stricture of about 2 cm in posterior urethra. He underwent resection of strictured segment and end-to-end anastamosis via preanal anterior coronal approach with an uneventful postoperative period [Figure 2] and [Figure 3]. Repeat MCU/RGU and uroflowmetery were done after 3 months which were normal, hence the suprapubic catheter was removed. Presently, child is 6 years of age and is in close follow-up and doing well without any urinary complaints.
| :: Discussion|| |
Though cystoscopic valve ablation appears to be a minor procedure, it is associated with complications and with rates varying from 5-25%.  The reported incidence of urethral stricture post ablation varies from 0-25%.  Posterior urethral stricture is considered the most debilitating injury because, if not managed properly, it can lead to severe impairment of quality of life, by affecting continence and potency. There are several treatment options for managing urethral strictures in children. In general they include; urethral dilatation, endoscopic visual internal urethrotomy, and open urethral reconstruction. Sarhan et al., in their study of 291 cases showed urethral stricture to be present in six (2%) cases post ablation and all were managed by visual internal urethrotomy and urethral dilatation.  Post ablation stricture formation is a tricky as surgeons can presume that it is the residual valve which is causing the symptoms and not the stricture. Thus, the role of MCU, RGU, and uroflowmetry is of utmost importance. Preanal anterior coronal approach is stablished for managing cases of aphallia and then further extended to include posterior urethral strictures as well.  It is different from perineal approach in terms of incision, better exposure, minimal blood loss, and ability to tackle rectourethral fistula in same setting. To conclude, the possibility of urethral stricture should be kept in mind while dealing with the problem of poor steam post ablation in cases of PUV.
| :: References|| |
|1.||Singh A, Panda SS, Bajpai M, Jana M, Baidya DK. Our experience, technique and long-term outcomes in the management of posterior urethral strictures. J Pediatr Urol 2013;pii:S1477-5131(13)00151-4. |
|2.||Lal R, Bhatnagar V, Mitra DK. Urethral strictures after fulguration of posterior urethral valves. J Pediatr Surg 1998;33:518-9. |
|3.||Nijman RJ, Scholtmeijer RJ. Complications of transurethral electroincision of posterior urethral valves. Br J Urol 1991;67:324-6. |
|4.||Sarhan O, ElHafez A, Dawaba M, Ghali A, Ibrahiem el-H. Surgical complications of posterior urethral valve ablation: 20 years experience. J Pediatr Surg 2010;45:2222-6. |
|5.||Bajpai M. Scrotal phalloplasty: A novel surgical technique for aphallia during infancy and childhood by pre-anal anterior coronal approach. J Indian Assoc Pediatr Surg 2012;17:162-4. |
[Figure 1], [Figure 2], [Figure 3]