Urethroplasty in Children: Experience at Tertiary Care Hospital, Peshawar, Pakistan

Research Article

Austin Med Sci. 2021; 6(3): 1055.

Urethroplasty in Children: Experience at Tertiary Care Hospital, Peshawar, Pakistan

Khan MK¹, Haroon N²*, Arshad¹, Kakakhel MK¹, Ullah N¹ and Wahab MU¹

¹Institute of kidney diseases, Peshawar, Pakistan

²Lady Reading Hospital Peshawar, Pakistan

*Corresponding author: Naveed Haroon, Lady Reading Hospital Peshawar, Pakistan

Received: September 25, 2021; Accepted: October 26, 2021; Published: November 02, 2021


Objectives: The aim of this study is to share single center experience of urethroplasty in pediatric age group.

Material and Methods: All boys of age less than 14 years who underwent urethroplasty at institute of kidney diseases from July 2017 to December 2020 are included in this study. The details received from hospital record system on a structured proforma and analysis was performed with SPSS version 20.

Results: Total 75 pediatric patients with mean age of 8 ± 3.2 years are included. The main etiology identified was trauma (57.3%) followed by iatrogenic (30.7%), unknown/ idiopathic (8%) and post inflammatory (4%) causes. The commonest site of urethral stricture was bulbar (62.7%), which resulted in the majority of cases from trauma. Other sites were penile in 21% and posterior urethral in 16%. The end to end urethroplasty was the leading surgical procedure (85.3%) in these patients, penile skin flap and two stage urethroplasties were performed in 9.3% and 5.3% patients respectively. Urethroplasty was found highly successful (93.3%) in the treatment of urethral stricture disease.

Conclusion: Children with history of perinial trauma and urethral instrumentation needs proper evaluation for lower urinary tract symptoms, as there is high suspicion of urethral stricture disease. Urethroplasty as the treatment of urethral stricture disease when performed in the specialized center is very effective modality of treatment.

Keywords: Urethral stricture; End to end urethroplasty; Penile skin flap urethroplasty; Two stage urethroplasty; Visual optical urethrotomy


Urethral stricture is the final common result of a variety of insults to the urethra. Urethral stricture is defined as “Permanent narrowing of the urethra which impede urinary flow during voiding”, it is one of the earliest urologic problem [1]. The terms urethral stricture and urethral rupture should be differentiated. The stricture is narrowing of urethral lumen, which results from changes in the urethral wall caused by either trauma or inflammation. Rupture is separation (partial or complete) of the traumatized urethral margins, which subsequently result in the formation of fibrous tissue in between the two ends [2]. Its management has a couple of challenges in the form of small pelvic confines, narrow caliber urethra and fragile perianal tissue [3]. The common causes are trauma from pelvic fracture, straddle and iatrogenic urethral injuries [4].

When treating urethral stricture disease, several factors should be considered before constructive procedure. Site, size, etiology and previous interventions help guide proper treatment option. Urethral dilatation was the earliest modality of treatment [1], later in 1974 Sachse introduced the direct vision internal urethrotomy by cold-knife incision [5]. In about half of the children the urethral dilatation and direct visual urethrotomy is deemed unsuccessful, so urethroplasty should be considered earlier in the management plan [6]. Still the major treatment options currently includes optical urethrotomy (less than 1-2 cm) and urethroplasty (preferred) [7].

Here we are sharing our experience of urethroplasty in children, regarding etiology, site of stricture, procedures performed and treatment outcome.

Materials and Methods

Following approval from research ethics committee of the institute of kidney diseases and transplant, this observational study included all boys of age less than 14 years who underwent urethroplasty in this institute from July 2017 to December 2020. The outcome was defined by the satisfactory micturition stream noted clinically and continuity of the full length urethral calibre by micturition cystourethrogram. The data collected retrospectively from hospital record system, which detailed the age, aetiology, location of stricture, type of surgical modality and finally the outcome. The analysis was done with IBM® SPSS®, version 20.0.


This study included 75 patients of urethroplasty for urethral stricture with mean age of 8 years (Std. Deviation 3.2), range (3 to 14 years). The etiology of urethral stricture was trauma in 57.3% (43/75), iatrogenic in 30.7% (23/75), unknown in 8% (6/75) and inflammatory in 4% (3/75). The major cause of bulbar stricture was trauma 65.9% (31/47), that of penile stricture was iatrogenic 81.2% (13/16) and all posterior urethral strictures were caused by trauma 100% (12/12). The etiology by age is shown in Table 1. Broadly up to the age of 5 years the leading cause was iatrogenic 80% (16/20), between 6-10 years major cause was trauma 63.6% (21/33) and after 10 years of age all strictures were caused by trauma. The common site was bulbar 62.7% (47/75), followed by penile 21% (16/75) and posterior urethra 16% (12/75). The type of surgical procedure is shown in Figure 1, with end to end urethroplasty performed in the majority of patients that’s in 85.3% (64/75), penile skin flap in 9.3% (7/75) and two stage urethroplasty in 5.3% (4/75). The indications for urethroplasty as the required treatment option were, recurrence after Visual optical urethrotomy in 43.7% (26/75), blind stricture in 24% (18/75), failed Visual optical urethrotomy in 21.3% (16/75), longer length (>2cm) in 10.7% (8/75) and re-do surgery in 9.3% (7/75). The urethroplasty was successful in 93.3% (70/75) and failed to achieve the success in 6.7% (5/75).

Citation: Khan MK, Haroon N, Arshad, Kakakhel MK, Ullah N and Wahab MU. Urethroplasty in Children: Experience at Tertiary Care Hospital, Peshawar, Pakistan. Austin Med Sci. 2021; 6(3): 1055.