Adamakis et al. Journal of Medical Case Reports 2012, 6:94 http://www.jmedicalcasereports.com/content/6/1/94 All of the above approaches cannot be safely used in the presence of an AUS due to urethral narrowing. In our patient the passage to the area of the stenosis was difficult. Thus, the use of the 11F rigid ureteroscope along with the Ho:YAG laser seemed to be the ideal treatment for our patient since the flexible end-firing fiber of the laser made the access to the stricture easier. Furthermore, with the holmium laser we could control the firing pulses accurately with a foot switch; thus damage to the collateral healthy tissue was pre- vented [14], which is very important especially in a patient with an AUS who presents with a recurrent UVA. In general, instrumentation to the urethra in such patients could lead to urethral erosion, subse- quent AUS removal and all the relevant repercussions for the patient. In an effort to minimize the danger of erosion, mini- mally invasive techniques are required. An interesting approach was reported by Eltahawy et al. using a pedia- tric cystoscope [4]. The small caliber of this scope (7.5F) is ideal for passing through a narrowed urethra. How- ever, we decided to try a pediatric resectoscope (9F) (Figure 1) due to our previous failure with the Ho:YAG laser. The intra-operative use of the resectoscope was excellent, allowing for a potent recanalization. Two important issues should be mentioned: the first is related to the movement of the resectoscope, which is passive. The second one concerns the resected chips, which are easily removed by irrigation saline via the working channel of the resectoscope due to their small size. We advocate the presence of a pediatric scope in an adult urological department, despite its cost, because it can be life saving in cases of urethral stenosis in general. Conclusions Patients who are post-RP with an implanted AUS with the complication of an UVA contracture can be difficult to manage due to narrowing of the urethra. Although the ideal treatment for recurrent UVA strictures remains debatable, our case shows that the urologist must be aware of several treatment options, especially when a plethora of instruments are available. Use of a rigid ureteroscope or the pediatric resectoscope seems appealing due to their small caliber, but larger patient series and longer follow-up periods are essential in order to draw safe conclusions. Consent Written informed consent was obtained from the patient for publication of this manuscript and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Page 4 of 5 Author details 1Department of Urology, Athens University Medical School-LAIKO Hospital, Athens, Greece. 2Department of Anesthesiology, LAIKO Hospital, Athens, Greece. 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