Direct Vision Internal Urethrotomy (DVIU) and Regular Clean Self Intermittent Catheterization (CSIC) For Short Bulbar Urethral Strictures: A Durable Solution

DVIU and CSIC

  • Pankaj Trivedi Assistant Professor, Department of Urology, Geetanjali Medical College & Hospital, Udaipur, Rajasthan, India
Keywords: Clean Self-Intermittent Catheterization, Direct Vision Internal Urethrotomy, Urethral Strictures, Recurrence

Abstract

Background: To evaluate durability of DVIU results and recurrence of stricture if the CSIC was done regularly up to one year and weekly thereafter. Subjects and Methods: This retrospective study was conducted in the Department of Urology at tertiary care teaching hospital of Rajasthan, India. Files of all patients operated between January 2015 and July 2018 for single bulbar urethral strictures of less than 1-1.5cm size in length, iatrogenic, idiopathic, traumatic or inflammatory origins were evaluated. Patient with multiple or complicated strictures of post urethroplasty, post hypospadias repair, previous radiation or multiple DVIU were excluded from the study. Data of all patients who were on CSIC following direct vision internal urethrotomy were evaluated at 3, 6, 12 and 24 months. Results: Mean age of patients was 41.13 years with range in between 26-74 years. Most common cause of urethral strictures were idiopathic 66 (58.92%) followed by iatrogenic 27 (24.11%) causes. After 24 months of follow up 95 (84.82%) patients maintained urethral caliber up to 16 Fr. Failure or recurrence was found in 17 (15.18%) patients who required intervention. Conclusion: Direct vision internal urethrotomy (DVIU) with regular clean intermittent self-catheterization (CSIC) was found good success rate in bulbar urethral strictures upto 1 cm in selected patients.

Downloads

Download data is not yet available.

References

Stein MJ, Desouza RA. Anterior urethral stricture review. Transl Androl Urol. 2013;2(1):32–38. Available from: https://dx.doi.org/10.3978/j.issn.2223-4683.2012.11.05.

Alwaal A, Blaschko SD, Mcaninch JW, Breyer BN. Epidemiol- ogy of urethral strictures. Transl Androl Urol. 2014;3(2):209–

Available from: https://dx.doi.org/10.3978/j.issn.2223-4683.2014.04.07.

Bergamin PA, Kiosoglous AJ. Surgical management of recurrent urinary tract infections: a review. Transl Androl Urol. 2017;6(S2):S153–S162. Available from: https://dx.doi.org/10.21037/tau.2017.06.17.

Pal D, Kumar S, Ghosh B. Direct visual internal urethrotomy: Is it a durable treatment option? Urol Ann. 2017;9(1):18–18. Available from: https://dx.doi.org/10.4103/0974-7796.198835.

Dubey D. The current role of direct vision internal urethrotomy and self-catheterization for anterior urethral strictures. Indian J Urol. 2011;27(3):392–398. Available from: https://doi.org/10.4103/0970-1591.85445.

Lawrence WT, MacDonagh RP. Treatment of Urethral Stric- ture Disease by Internal Urethrotomy followed by Intermittent ‘Low-Friction’ Self-Catheterization: Preliminary Communica- tion. J ROY SOC MED. 1988;81(3):136–139. Available from: https://dx.doi.org/10.1177/014107688808100306.

Zehri AA, Ather MH, Afshan Q. Predictors of recurrence of urethral stricture disease following optical urethrotomy. Int J Surg . 2009;7(4):361–364. Available from: https://dx.doi.org/10.1016/j.ijsu.2009.05.010.

Kjaergaard B, Walter S, Bartholin J, Andersen JT, Nohr S, Beck H, et al. Prevention of urethral stricture recurrence using clean intermittent self-catheterization. Br J Urol. 1994;73(6):692– 695. Available from: https://dx.doi.org/10.1111/j.1464-410x.1994.tb07558.x.

Roosen JU. Self-Catheterization after Urethrotomy. Urol Int. 1993;50(2):90–92. Available from: https://dx.doi.org/10.1159/000282459.

Lauritzen M, Greis G, Sandberg A, Wedren H, Öjdeby G, Henningsohn L. Intermittent self-dilatation after internal urethrotomy for primary urethral strictures: A case–control study. Scand J Urol Nephrol. 2009;43(3):220–225. Available from: https://dx.doi.org/10.1080/00365590902835593.

Tunc M, Tefekli A, Kadioglu A, Esen T, Uluocak N, Aras N. A prospective, randomized protocol to examine the efficacy of postinternal urethrotomy dilations for recurrent bulbomembra- nous urethral strictures. Uro. 2002;60(2):239–244. Available from: https://dx.doi.org/10.1016/s0090-4295(02)01737-5.

Jackson MJ, Veeratterapillay R, Harding CK, Dorkin TJ. Intermittent self-dilatation for urethral stricture disease in males. Cochrane Database Syst Rev. 2014;19(12):10258– 10258. Available from: https://doi.org/10.1002/14651858.cd010258.pub2.

Ivaz SL, Veeratterapillay R, Jackson MJ, Harding CK, Dorkin TJ, Andrich DE, et al. Intermittent self-dilatation for urethral stricture disease in males: A systematic review and meta- analysis. Neurourol Urodyn. 2016;35(7):759–763. Available from: https://dx.doi.org/10.1002/nau.22803.

Pansadoro V, Emiliozzi P. Internal Urethrotomy in the Man- agement of Anterior Urethral Strictures: Long-Term Followup. J Urol. 1996;156(1):73–75. Available from: https://dx.doi.org/10.1016/s0022-5347(01)65942-1.

Holm-Nielsen A, Schultz A, Møller-Pedersen V. Direct Vision Internal Urethrotamy. A Critical Review of 365 Operations. Br J Urol. 1984;56(3):308–312. Available from: https://dx.doi.org/10.1111/j.1464-410x.1984.tb05393.x.

Greenwell TJ, Castle C, Andrich DE, MacDonald JT, Nicol DL, Mundy AR. Repeat Urethrotomy and Dilation for the Treatment of Urethral Stricture Are neither Clinically Effective nor Cost- Effective. J Urol . 2004;172(1):275–277. Available from: https://dx.doi.org/10.1097/01.ju.0000132156.76403.8f.

Published
2020-12-27