Impact of congenital narrowing of the bulbar urethra (Cobb's collar) and its transurethral incision in children

Objectives: We described the clinical manifestation and outcome after trans urethral incision (TUI) of a congenital narrowing of the bulbar urethra (Co bb's collar). Materials and Methods: Over a period of 11 years a total of 1 4 boys, from 3 months to 16 years old with a mean age of 5 years, were subj ected to TUI. A febrile urinary tract infection (UTI) was the most common s ymptom in 40 cases, enuresis in 15, urinary incontinence in 11, hematuria i n 9, antenatally diagnosed dilated urinary tract in 4 and others in 9. Conc urrent bladder instability was detected by cystometry in 27/31 boys older t han 3 years with suspicious bladder urgency. When the bulbar narrowing was detected by cystourethroscopy under 8 Fr, the lesion was simultaneously inc ised by using an infantile resectoscope (Olympus 10 Fr with a knife electro de or Storz 10 F with a cold knife). Results: Vesicoureteral refluxes (VURs ) occurred in 39 cases (53%) and it was diminished in 11 and improved in 25 after TUI. Of the 40 cases, 38 (95%) were free from UTI after TUI. For enu resis and urinary incontinence, 14/15 and all 11, respectively, thrived aft er TUI and the anticholinergic supplement. Although 61 cases were primarily cured with no complications, insufficient cutting and recurrence of the st ricture required an additional TUI in 13 cases for whom the knife; electrod e was mostly used. Overall clinical improvement was obtained in 71/74 (93%) cases after TUI. Conclusion: Meticulous cystourethroscopy is indispensable for detecting a clinically significant bulbar narrowing. TUI of the lesion is useful as a primary treatment in the majority of cases even with concur rent VUR and unstable bladder. A cold knife is preferable to electrocautery in incising this fine anterior urethral lesion.