After excision of the scarred portions of the urethra, the defect of the urethra was 20 mm in length (Fig. 1). Because approximation of the normal urethra without tension seemed difficult, the bulbar urethra was exposed through a short midline perineal longitudinal incision and was subsequently

mobilized from the bulbar penile junction back to the bulbomembranous junction. The entire length of the proximal penile urethra was dissected through a perineal incision, and the entire length of the anterior urethra was mobilized (Fig. 2A). Single-stage end-to-end anastomosis to the proximal and distal urethral ends without tension could be performed simultaneously (Fig. 2B). In addition, ventral penile curvature was never observed (Fig. 2C). The urethral catheter was placed 2 weeks postoperatively. The postoperative course was uneventful. Uroflowmetry performed C59 wnt order 1 year after surgery showed a bell-shaped pattern, the maximum urine flow was 13.6 mL/s, the mean flow rate was 8.8 mL/s, and voided volume was 132 mL, with little postvoid residual urine. Urethral strictures are the most click here common cause of obstructed micturition in adults and frequently recur after initial treatment. Anterior urethral strictures commonly occur because of iatrogenic or idiopathic causes. Many treatment options exist for anterior urethral strictures in adults. Urethral dilatation with metal

those sounds is the oldest form of treatment,2 but it has only a temporary effect, and the stricture could recur. EIU

is also associated with a high recurrence rate, and the long-term success rate is only 20%.3 End-to-end anastomosis is performed for patients with stricture lengths <25 mm.4 This procedure has excellent success rates of >90%5 when the urethra is approximated without tension and the anastomosis has sufficient blood supply. However, urethral stricture is a rare condition in the pediatric population, and its treatment is one of the most difficult problems.1 Anterior urethral strictures in children mainly develop subsequent to hypospadias repair or trauma.6 The treatment options for anterior urethral strictures are urethral dilatation with metal sounds, EIU, end-to-end anastomosis, or single-stage or multiple-stage urethroplasty with a pedicled skin flap or buccal mucosa graft.7 The success rates are comparable with those of adult cases. Because anterior urethral strictures are mainly caused by hypospadias repair in pediatric patients and the blood supply to the distal urethra may be shifted and limited, end-to-end anastomosis is rarely selected for treatment in pediatric patients although it has achieved excellent success rates. In this report, we described a patient with intractable recurrent anterior urethral stricture who underwent urethral dilatation using metal sounds and EIU several times.