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

Introduction: Urethral strictures following endoscopic management of Posterior Urethral Valves (PUV) varies from 0 % to 25 % and occurs due to iatrogenic injury of the urethra.

Objectives: To assess the outcomes of children undergoing urethral reconstruction following an iatrogenic injury during endoscopic management of PUV.

Methods: A retrospective review of a prospectively maintained database from 2015 to 2023 was undertaken of children who were referred following an iatrogenic injury to the urethra from prior endoscopic management of PUV.

Results: Seven boys with a history of PUV were referred following an iatrogenic bulbar urethral injury. All presented by age 2 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 5 patients who had no prior attempted urethroplasty, underwent a dorsal onlay. The 2 patients who had an attempted anastomotic urethroplasty with subsequent failure, both presented with bulbar necrosis. A pedicled preputial flap was used for both patients for reconstruction.

Conclusion: Iatrogenic injury of the urethra can occur during endoscopic ablation of PUV. Urethroplasty is successful and best performed with a preputial skin graft if available.