Treatment of Male Urethral Strictures: Is Repeated Dilation or Internal Urethrotomy Useful?

Heyns, Chris F.; Steenkamp, Janami; Kock, M. L. S. De; Whitaker, Paul

doi:10.1016/s0022-5347(01)62894-5

Cited by 283 publications

(193 citation statements)

References 27 publications

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“…Indeed, in both countries, the common perception is that internal urethrotomy or dilation is appropriate management of strictures that, based on currently available evidence, would be better treated with urethroplasty. Several series demonstrate that the success rate with urethral dilation or urethrotomy for strictures over 2cm or recurrent strictures in unacceptably low (2,3). Yet, rather than a misunderstanding about treatment effectiveness, these practice patterns may merely represent the reality that properly trained reconstructive urologists are not available in many parts of the world, even in highly industrialized countries like the Netherlands and U.S. Only 3% of urologists surveyed performed more than 5 urethroplasties a year.…”

Section: Editorial Commentmentioning

confidence: 99%

Management of Adult Anterior Urethral Stricture Disease: Nationwide Survey Among Urologists in The Netherlands

et al. 2011

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Background: Adult anterior urethral stricture disease is most often treated with dilatation or direct vision internal urethrotomy (DVIU). Although evidence suggests that anastomotic urethroplasty for short bulbar strictures is more efficient and cost effective in the long term, no consensus exists. It is unclear by whom and how often urethroplasties are performed in The Netherlands and how results are being evaluated. Objective: To determine national practice patterns on management of anterior urethral strictures among Dutch urologists. This information will help to define the nationwide need for training in urethral surgery. Design, Setting, and Participants: We conducted a 16-question survey among all 323 Dutch urologists. Results and Limitations: The response rate was 74%. DVIU was practised by 97% of urologists. Urethroplasty was performed at least once yearly by 23%, with 6% performing more than five urethroplasties annually. In the group of urologists younger than 50 yr of age, 13% performed urethroplasty, with 3% of those performing more than five annually. In the case of a 3.5-cm-long bulbar stricture, DVIU was preferred by 49% of responders. Even after two recurrences, 20% continued to manage a 1-cm-long bulbar stricture endoscopically. Of responders, 79% believed that urethroplasty should be proposed only after a failed endoscopic

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Section: Editorial Commentmentioning

confidence: 99%

Management of Adult Anterior Urethral Stricture Disease: Nationwide Survey Among Urologists in The Netherlands

et al. 2011

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“…By incising the urethra via urethrotomy, the vascularity within the underlying corpus spongiosum might be destroyed during the procedure, which could exacerbate the ischemic spongiofibrosis and lead to the recurrence of stricture. In light of this, the place of DVIU in the treatment algorithm for male urethral stricture disease has been questioned (Heyns et al, 1998;Hudak et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

High-pressure balloon dilation for male anterior urethral stricture: single-center experience

Wang

et al. 2016

J. Zhejiang Univ. Sci. B

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Abstract:Objectives: We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation (HPBD) technique for anterior urethral stricture. Methods: From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy (DVIU). Patient demographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results: The operation time was much shorter for the HPBD procedure than for the DVIU ((13.19±2.68) min vs. (18.44±3.29) min, P<0.01). For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection (UTI) were less frequently encountered than those in DVIU (urethral bleeding: 2/31 vs. 8/25, P=0.017; UTI: 1/31 vs. 6/25 P=0.037). The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups (P=0.21, hazard ratio (HR)=0.65, 95% confidence interval (CI): 0.34 to 1.26). However, there was a significantly higher stricture-free survival in the HPBD group at 12 months (P=0.02, HR=0.35, 95% CI: 0.14 to 0.87), which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions: HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.

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“…When performed to manage recurrent strictures, the cure rate approaches zero, when cure is defined as durable wide urethral patency without the need for subsequent treatment to maintain a wide caliber. 9,10 It is our observation that dilation is an overused management option, because patients with urethral stricture disease are often treated with dilation when they can be cured with a properly performed urethroplasty. We are in no way suggesting that direct vision balloon dilation may offer a higher cure rate than other dilation methods.…”

Section: Role In Urologic Practicementioning

confidence: 99%

Direct Vision Balloon Dilation for the Management of Urethral Strictures

Gelman

Liss

Cinman

2011

Journal of Endourology

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Urethral strictures are often initially managed with dilation using sequential metal sounds or filiform and follower dilators. While these techniques often successfully achieve at least a temporary increase to the caliber of the area of stricture, they are performed without visual guidance, and complications can include false passage and urethral perforation. We describe the first use of balloon dilator that allows the safe, controlled, and gentle and dilation of urethral strictures under direct vision.

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Treatment of Male Urethral Strictures: Is Repeated Dilation or Internal Urethrotomy Useful?

Cited by 283 publications

References 27 publications

Management of Adult Anterior Urethral Stricture Disease: Nationwide Survey Among Urologists in The Netherlands

Management of Adult Anterior Urethral Stricture Disease: Nationwide Survey Among Urologists in The Netherlands

High-pressure balloon dilation for male anterior urethral stricture: single-center experience

Direct Vision Balloon Dilation for the Management of Urethral Strictures

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