"When ablation goes wrong"- urethral strictures after ablation of posterior urethral valves-characteristics, management and outcomes".
BACKGROUND
Post-ablation urethral strictures are a rare but devastating complication following transurethral ablation of posterior urethral valve which can be more difficult to treat than the valve itself. Though with the miniaturization of scopes the incidence of these strictures has decreased, sadly they still continue to occur. Hence, literature on these strictures is also limited due to the rarity of occurrence.


OBJECTIVE
To analyze the management strategies and outcomes of post-valve-ablation urethral strictures managed in a tertiary care center.


MATERIALS AND METHODS
A retrospective review of all boys with the diagnosis of urethral strictures who had undergone management in our center from January 2000 to July 2017, with a minimum follow-up data for 12 months following interventions was done and among them the subset who developed strictures following valve ablation were identified. We also included those patients who had been referred for management of strictures following ablation elsewhere and had all their preoperative and operative details recorded. Out of a total of 199 boys who had undergone management of stricture during this time period, 13 boys with stricture of urethra following valve ablation were identified and studied. The history, presentation, timeline of events leading to stricture formation, possible predisposing factors, characteristics of strictures, mode of management and outcomes were recorded.


RESULTS
Among the 13 boys, 5 had developed strictures following in-house fulguration while 8 developed strictures following ablation elsewhere. The median age at diagnosis in these patients was 8 years (range, 3-18). The length of stricture varied from very short in the proximal bulbar to long penobulbar stricture. Median length of strictures was 10 mm (range: 3-35). Of the 9 patients who underwent primary endoscopic intervention, 8 had successful outcomes (88.7%) while one patient ultimately required open urethroplasty. Of the 4 patients who had open intervention, except the patient who underwent meatoplasty, the rest needed multiple surgical and endoscopic interventions. Median follow up period was 20 months (range: 12-68).


CONCLUSION
Urethral Stricture disease continues to be a rare but significant complication of valve ablation. Post ablation stricture can happen in any part of the urethra. Our data suggests that if a DVIU or dilatation is to be implemented for the treatment of a stricture after ablation, it may be most suitable for short, proximal strictures. Proper technique of valve ablation by a dedicated pediatric urologist using a proper sized resectoscope with proper isolation of electrode from the rest of urethral wall is crucial to prevent these strictures.