[Urethral stenosis in the young girl, myth or reality? Comparison of clinical, radiological, instrumental and urodynamic data (author's transl)].
In 240 girls aged between three and fifteen years with mictional problems or urological infectious complications, 58 had radiological appearances of urethral stenosis. A complete clinical, urographic, urodynamic, endoscopic and instrumental study was performed in these 58 children. The majority of these young girls suffered from frequency with urgency, enuresis, pyuria and radiological and endoscopic appearances of trabeculated bladder. Thirteen showed signs of vesico-ureteric reflux. A basic fact: only two of the children had meatal stenosis. All the others had a urethral calibre larger than normal. Almost all the children had an unstable bladder, but with the exception of the two girls with a tight meatal stenosis, none had urodynamic data compatible with poor stream or vesico-sphincter dysinergism. The author concluded in the existence and the exceptional nature of true stenosis of the terminal urethra in the young girl. Most often, in the absence of true stenosis, there is nevertheless a functional stenosis related to contraction of the striate sphincter intended to overcome contraction of the unstable bladder. Such non-inhibited bladders are the site of marked disinhibition contractions without any element of outlet obstruction no increase in urethral resistance and no increase in micturation pressures. Disturbances of day and night continence are essential. Vesical trabeculations are a logical consequence, easy to understand, but the episodes of recurrent infection and the development of vesico-ureteric reflux (present in 13 of the girls) are rather more complicated to explain. This pathological state is most often reversible as the bladder matures. Nevertheless, bladder education, pharmacological treatment, dilatations and urethrotomy may help such children. Such treatment has given favourable results in 50% of cases.