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BACK TO THE FUTURE: URETHRAL OVER-DILATATION IN GIRLS FOR REFRACTORY LOWER URINARY TRACT DYSFUNCTION IS EFFECTIVE BY OBJECTIVE PARAMETERS.
Artan Koni, FEBU1, Hasan S. Dogan, Assoc. Prof.1, Metin Hascicek, Specialist2, Serdar Tekgul, Prof.1.
1Hacettepe University School of Medicine, Ankara, Turkey, 2Ankara Training and Research Hospital, Ankara, Turkey.

BACKGROUND:
To prospectively determine the effect of urethral dilatation in girls with refractory lower urinary tract symptoms (LUTS).
METHODS:
Between December 201-July 2013, 25 girls with LUTS who remained refractory to standard urotherapy, underwent urethral over-dilatation under general anesthesia. Besides demographic data, history of urinary tract infection (UTI), upper tract condition, uroflowmetry (UF) parameters, vesicouretereal reflux (VUR) and voiding dysfunction symptom scores (VDSS) were recorded pre- and postoperatively. Urethral dilatation was performed using Hegar dilatators up to 8 or 9 mm, waiting several seconds and using a 0.5 mm thicker dilatator each time. Submucosal injection (STING) was performed intraoperatively in 5 patients (7 renal units). Patients were assessed with 3 months intervals postoperatively.
RESULTS:
Mean age and mean follow-up was 8.3(5-12) years and 9.6(3-17) months, respectively. Mean max Hegar dilation performed was 8.5 (8-9) mm. Twenty patients had postoperative follow-up. Five of 20 patients (7/40 renal units) those all had low grade VUR underwent STING intraoperatively. Postoperative evaluation revealed significant improvement in terms of UTI (p<0.001), upper tract dilatation (p=0.043) and postvoiding residual urine measurements (Pre- vs postoperative: 73.2 vs 11.4 cc, p<0.001). VDSS (total) decreased from 12.3 to 4.5 (p=0.001). Improvement in daytime wetting (p=0.017), daytime wetting severity (p=0.003), voiding frequency (p=0.018) and postponing maneuvre (p=0.003) scores were significant.
CONCLUSIONS:
In this prospective trial on a selected group of patients (dysfunctional voider girls who remained non responsive to urotherapy) urethral over-dilatation is shown to be useful, as it reduces the number of UTI, wetting episodes and PVR volume resulting in higher quality of life.


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