| Abstract [eng] |
Aim and tasks. To analyse selected scientific articles describing endoscopic and open surgical treatment methods of paediatric urethral strictures. To review endoscopic and open surgical treatment methods of urethral strictures in children, their effectiveness, postoperative complications, and recurrence rates depending on the treatment method. Methods. A systematic review of the literature was performed using the Cochrane Library and the PubMed search system in the electronic MEDLINE database. Articles written in English and published after 2009, describing children treated for urethral stricture with endoscopic or open surgical methods were selected. Results. Eight articles were included in the systematic review, which made a total of 317 patients. The results of endoscopic treatment, frequency of postoperative complications, and recurrence rates were discussed in 3 scientific articles, success rate of urethrotomy using holmium yttrium–aluminium–garnet laser was 62.1 percent, “cold knife” urethrotomy success rate was 71 percent respectively. One of the articles compared “cold knife” urethrotomy and urethrotomy using holmium yttrium–aluminium–garnet laser, success rate was 47.61 percent and 76.2 percent respectively. Results of the surgical urethroplasty were discussed in 3 scientific articles. In one of them success rate varied from 88.9 percent to 89.5 percent, in others, success rate was 69.2 percent and 25 percent respectively. One article discussed the results of surgical urethroplasty associated with hypospadias and the established success rate was 100 percent. The last article compared endoscopic and open surgical treatment methods while treating patients with urethral strictures developed after hypospadias surgery. The success rate was 17 percent versus 67 percent. Conclusions. During this systematic literature review, it was found that direct vision internal urethrotomy using holmium yttrium–aluminium–grenade laser is a safe method which provides acceptable treatment outcomes and is associated with a lower incidence of postoperative complications and recurrence while treating paediatric urethral strictures of any aetiology, which are shorter than 2 cm. Urethroplasty with end–to–end anastomosis or buccal mucosa graft is associated with better treatment outcomes, lower rates of postoperative complications and recurrence in comparison with other surgical treatments. When choosing a surgical method, it is necessary to evaluate each clinical situation individually. Recommendations for further research. Multicenter prospective studies including larger patient numbers are warranted, monitoring for late complications, and including urinating and erectile functional studies. |
