Catheter dwell time and diameter affect the recurrence rates after internal urethrotomy

Abstract

Objective: Cold-knife direct vision internal urethrotomy (DVIU) is frequently used as the first-line treatment for urethral stricture disease. Although the steps of the procedure are defined in detail, the duration of catheterization and the diameter of the catheter to be used after the operation are not clearly defined. The aim of this study is to evaluate the effects of catheter dwell time and diameter on recurrence rates of urethral stricture disease after DVIU. Material and methods:Data of 193 consecutive treatment naïve bulbar urethral stricture patients who underwent DVIU between January 2009 and June 2013 were retrospectively analyzed. Patient demographics and stricture characteristics were noted. Catheter dwell times were grouped as <5 and ≥5 days. The diameters of catheters used were 16, 18 and 22 Fr. The association between recurrence rates, catheter dwell times, and diameter were evaluated with Tukey's test and Pearson's correlation test, respectively. Results:Overall 193 patients with a mean age of 64.51±12.99 (range: 17 to 85) years were enrolled in the study. Urethral stricture disease recurred in 45 (23.31%) patients within the first year after DVIU. Mean duration of catheterization was 7.47±4.03 and 4.79±1.94 days in patients with and without recurrences, respectively (p=0.0001). Catheter dwell times for ≥5 days were also associated with increased recurrence (p=0.0001). Of the patients with recurrent strictures, 16, 18 and 22Fr catheters were placed in 22.22%, 20% and 57.78% of the patients, respectively. Increased catheter diameter was also associated with higher recurrence rates (p=0.004). Conclusion:Shortening the postoperative duration of catheterization and decreasing the catheter size may result in improved recurrence rates after DVIU. Further prospective randomized trials are necessary to confirm these findings.

Direct visual internal urethrotomy for isolated, post-urethroplasty strictures: a retrospective analysis

“…The urethral incision was considered adequate when the cystoscope or urethrotome easily passed into the bladder. An indwelling catheter was generally left for 3-7 days in our series, although recent data and the AUA guidelines suggest that a urethral catheter may be safely removed 72 h after an uncomplicated DVIU [Wessells et al 2016;Yuruk et al 2016]. Post-DVIU treatment success was defined as lack of symptomatology and no further need for additional interventions, including self-dilation.…”

“…An indwelling catheter was generally left for 3–7 days in our series, although recent data and the AUA guidelines suggest that a urethral catheter may be safely removed 72 h after an uncomplicated DVIU [Wessells et al . 2016; Yuruk et al . 2016].…”

Comparative review of the guidelines for anterior urethral stricture

“…Catheter characteristics could also play a role in stricture disease. EAU recommends avoiding non-coated latex catheterization due to the risk of urethritis/stricture [EAU: Strong] and the use of large catheters (> 18 Fr) for drainage-only purposes [EAU: Weak] [ [14][15][16][17].…”

Endoluminal and Endoscopic Management of Urethral Stricture

“…11,18,19,21,34,35 Some reports found that leaving the urethral catheter in-situ for longer than 3-5 days was associated with increased recurrence. 36,37 Studies on the effects of the size of the urethral catheter on stricture recurrence rate is limited. Yuruk, E et al reported decreasing the catheter diameter from 22Fr to 18Fr significantly decreases stricture recurrence rates.…”

“…Yuruk, E et al reported decreasing the catheter diameter from 22Fr to 18Fr significantly decreases stricture recurrence rates. 37 It is postulated that larger bore urethral catheters potentially exert greater pressure on the urethral wall, reducing blood flow and hindering the re-epithelialization process. This subsequently leads to the healing of the incised urethra with fibrosis, causing stricture recurrence.…”