AB001. SOH25_AB_049. Management of bulbar strictures in boys following previous endoscopic treatment of posterior urethral valves

Background: Literature reporting of the occurrence of urethral strictures following endoscopic management of posterior urethral valves (PUV) varies from 0% to 25% and occurs due to iatrogenic injury of the urethra.

Methods: A retrospective review of a prospectively maintained database from January 2015 to July 2023 was undertaken of children who were referred to Kulkarni Reconstructive Urology Centre, Urokul Hospital, following an iatrogenic injury from prior endoscopic management of PUV.

Results: Seven boys with a history of PUV were referred to our institution following an iatrogenic bulbar urethral injury. All presented by their 2nd year of life and all had multiple attempted dilatations performed in external institutions. Two patients had also undergone an anastomotic urethroplasty with subsequent failure and recurrence of the stricture in the bulbar urethra, to a near obliterative state. The five patients who had multiple previous urethral dilatations with no prior attempted urethroplasty, underwent a dorsal onlay. Regarding the two patients who had an attempted anastomotic urethroplasty with subsequent failure, both presented to our centre with bulbar necrosis. A pedicled preputial flap was used for both patients for reconstruction.

Conclusions: Iatrogenic injury of the urethra can occur in paediatric patients undergoing endoscopic ablation of PUV with the bulbar urethra being the most common site of injury. Urethroplasty is successful and best performed with a preputial skin graft if available.

Keywords: Urethroplasty; posterior urethral valves (PUV); reconstruction; bulbar stricture; iatrogenic injury