Otis internal urethrotomy in the treatment of urethral stricture disease

Intermittent self catheterization versus regular outpatient dilatation in urethral stricture: a comparison

BACKGROUND

The results of regular intermittent self catheterization were compared with regular outpatient dilatation after endoscopic internal urethrotomy for urethral strictures.

METHODS

The records of patients who were treated for urethral stricture disease over a 4-year period from 1991 to 1994 were reviewed. They were either on regular urethral dilatation or were advised to carry out self calibration. A follow-up questionnaire was sent to them and they were asked to attend a review. Student's t-test and Proportion Test were used to find out if there was any significant difference between the two groups.

RESULTS

There were 78 patients who were on self calibration and 49 patients on regular urethral dilatation. There was no significant difference between the two groups regarding the duration of follow-up (21.5 and 23.7 months, respectively); the length of stricture (1.5 and 1.7 cm, respectively); and complications (two and four, respectively). However, patients on self calibration had narrower strictures (4.8 and 5.7 F) and a significantly lower restricture rate (5 and 16%). The current urinary stream was compared to the immediate postoperative stream. This showed that a higher number of patients in the dilatation group were voiding at less than 25% of their immediate postoperative flow. People from high and low socio-economic groups were able to carry out self calibration satisfactorily.

CONCLUSION

Patients from high and low socio-economic groups found that self calibration resulted in a lower restricture rate and better stream when compared to regular urethral dilatation.

Long-term results of intermittent low-friction self-catheterization in patients with recurrent urethral strictures

OBJECTIVE

To ascertain the duration of intermittent low-friction self-catheterization (ILSC) required to cause stricture stabilization.

PATIENTS AND METHODS

Over a 4 year period, 101 patients with a median age of 62 years (range 16-85) with recurrent urethral strictures were recruited to the trial. All the strictures were treated by internal urethrotomy and the patients were then randomized to perform ILSC twice weekly for either 6 months (group 1) or 36 months (group 2). Out-patient follow-up with urinary flow rate was initially at 1 month and then at 3 monthly intervals. Stricture recurrence rates were compared between the two groups.

RESULTS

Of 101 patients, seven failed to attend after the first out-patient appointment. A further 21 died of unrelated disease whilst on ILSC (although 13 had been followed up for at least 24 months and so were included in the analysis). The median follow-up was 67 months (range 24-78). Ten patients in group 2, who had suffered from recurrent strictures, refused to stop catheterizing at the appointed time and all remain stricture-free on permanent ILSC. Of the remaining 76 patients, 48 catheterized for 6 months and 28 patients performed ILSC for 12 to 36 months (nine stopped earlier than intended). Forty per cent of patients who stopped at 6 months developed a recurrence compared with 14% who catheterized for more than 12 months (P < 0.05) (chi-square test with Yates' correction).

CONCLUSIONS

Our results indicate that ILSC is safe and effective in preventing stricture recurrence in the long term. The recurrence rate of urethral strictures was significantly lower when ILSC was continued for more than 12 months compared with ILSC that was stopped at 6 months. We conclude that catheterization for at least 1 year is required to achieve adequate urethral stabilization.

On the transurethral treatment of urethrostenosis in males

The paper deals with the authors' own experience in endoscopic treatment of urethrostenosis in males. Since 1980, 86 patients have been treated in this manner. Good results were obtained in 60 (70%) after one surgical procedure and in 18 (21%) after two operations. Two patients were operated upon by routine methods. We are of the opinion that transurethral treatment of urethrostenosis in males is an easy and simple method which may yield -- if properly performed -- very good therapeutic results, but requires appropriate equipment and high surgical skills.

Postoperative care following internal urethrotomy

A randomized prospective study was set up to assess the role of postoperative catheter drainage and the value of hydraulic self-dilatation of the urethra after internal urethrotomy. Sixty-two patients were admitted into the study and followed-up for two years. The results support the use of a no-catheter posturethrotomy management and advocate the encouragement of postoperative hydraulic self-urethral dilatation.

Strictures of the male urethra treated by the Otis method

During a 5-year interval 72 consecutive patients with urethral strictures were treated by internal urethrotomy according to the method of Otis. The etiology, surgical technique, complications and postoperative management are discussed. The results after a mean followup of 29 months showed an over-all success rate of 82 per cent (95 per cent confidence limits 71 to 90 per cent). It is concluded that internal urethrotomy should be considered for primary treatment of urethral strictures, since the procedure is easy and complications are few.