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Urethrotomy and Other Minimally Invasive Interventions for Urethral Stricture

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Book cover Urethral Reconstructive Surgery

Part of the book series: Current Clinical Urology ((CCU))

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Summary

The minimally invasive interventions most often used for treating urethral strictures are dilation and direct vision internal urethrotomy (DVIU), which are equally effective for the initial treatment of strictures. The reported success rate with DVIU varies from 66% to 90%, and declines progressively with longer follow-up. The recurrence rate is higher with previously treated, long (>2 cm), multiple strictures, penile compared with bulbar strictures, and those with perioperative infection. Specific contraindications to DVIU include suspicion of urethral carcinoma, bleeding diathesis, and active infection. The rate of stricture recurrence may be decreased by teaching the patient to do hydraulic self-dilation or clean intermittent self-catheterization, or by performing regular follow-up dilation in a clinic setting.

The advantages of dilation and DVIU are that they can be performed under local anesthesia in an outpatient setting, with a low complication rate (<10%) and virtually no risk of mortality. Because dilation does not require special endoscopic equipment or operating room facilities, it is the procedure of choice where facilities for DVIU are not available.

The optimal indications for dilation or DVIU are single, bulbar strictures shorter than 2 cm, with no inflammatory changes and no previous treatment. A second DVIU for early stricture recurrence (at 3 months) is of limited value in the short term (24 months) but of no value in the long term (48 months), whereas a third repeated dilation or DVIU is of no value. There is some evidence that DVIU is being used excessively and inappropriately because of its simplicity and ease of repetition, and because there is a lack of familiarity with urethroplasty.

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  1. Department of Urology, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa

    Chris F. Heyns

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  1. Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA

    Steven B. Brandes M.D., FACS

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Heyns, C.F. (2008). Urethrotomy and Other Minimally Invasive Interventions for Urethral Stricture. In: Brandes, S.B. (eds) Urethral Reconstructive Surgery. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59745-103-1_7

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