International Urology and Nephrology

, Volume 50, Issue 4, pp 605–609 | Cite as

Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife

  • Waseem Aboulela
  • Mohammed S. ElSheemy
  • Mahmoud Shoukry
  • Ahmed M. Shouman
  • Ahmed I. Shoukry
  • Waleed Ghoneima
  • Mohamed El Ghoneimy
  • Hany A. Morsi
  • Mostafa Abdel Mohsen
  • Hesham Badawy
Urology - Original Paper



To compare efficacy and safety of visual internal urethrotomy (VIU) using holmium laser (Ho:YAG) (group A) versus cold knife (group B) in children with urethral strictures. It may be the first comparative study on this issue in children.


This study compared Ho:YAG group, which was evaluated prospectively from January 2014 till January 2016, versus cold knife group, which was a historical control performed from March 2008 till February 2010. Children ≤ 13 years old with urethral strictures ≤ 1.5 cm were included successively. Recurrent cases, congenital obstructions and cases with complete arrest of dye in voiding cystourethrography were excluded. Scar tissue was incised at twelve o’clock. Outcome was compared using Student’s t, Mann–Whitney, Chi-square or Fisher exact tests as appropriate.


Each group included 21 patients. Mean age was 6.27 ± 3.23 (2–13) years old. Mean stricture length was 1.02 versus 1 cm in group A versus B, respectively (p = 0.862). Ten cases of penile/bulbous strictures and another 11 cases of membranous strictures were found in each group. There was no significant difference between both groups in preoperative data. Success rate for initial VIU was 66.7% in group A versus 38% in group B (p = 0.064). This was associated with significantly higher Qmax in group A (mean 16.52 vs 12.09 ml/s; p = 0.03). Success rate after two trials of VIU was 76.2% for group A and 47.61% for group B (p = 0.057). No complications were reported in both groups.


Laser VIU has a higher success rate than cold knife VIU for urethral strictures ≤ 1.5 cm in children with significantly higher Qmax. Both are easy to perform, low invasive and safe.


Children Stricture urethra Holmium:YAG laser Visual internal urethrotomy Cold knife 



Visual internal urethrotomy


Holmium laser


Voiding cystourethrography


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was in accordance with the ethical standards of the local ethical committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from parents of all children included in the study.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Waseem Aboulela
    • 1
  • Mohammed S. ElSheemy
    • 1
    • 3
  • Mahmoud Shoukry
    • 2
  • Ahmed M. Shouman
    • 1
  • Ahmed I. Shoukry
    • 1
  • Waleed Ghoneima
    • 1
  • Mohamed El Ghoneimy
    • 1
  • Hany A. Morsi
    • 1
  • Mostafa Abdel Mohsen
    • 1
  • Hesham Badawy
    • 1
  1. 1.Division of Pediatric Urology, Aboul-Riche Children’s HospitalCairo UniversityCairoEgypt
  2. 2.Urology DepartmentFayoum UniversityFayoumEgypt
  3. 3.Urology Department, Kasr Al-Ainy HospitalsCairo UniversityCairoEgypt

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