Urethral Dilatation in Women: Urologists' Practice Patterns in the UK

Abstract

Ann R Coll Surg Engl 2006; 88: 496-498 496Urethral dilatation has been advocated as empirical treatment for adult women with lower urinary tract complaints for long time. The discovery of a distal urethral ring by Lyon and associates led to the hypothesis that urethral stenosis was the cause of recurrent urinary tract infections (UTIs) and dysfunctional voiding in girls. 1 It was postulated that rupture of this ring by dilatation would relieve the obstruction. Kerr and associates decided on cutting this contraction ring with the otis urethrotome rather than dilating it with sounds.2 At the same time, they extended this procedure to include adult female patients.Although reviewing the literature reveals little solid evidence regarding the theoretical basis of this practice, several reports suggest that urologists are still practising urethral dilatation as treatment for a variety of complaints that are not efficiently managed by other means.To this end, we conducted a study to establish and report the results of an anonymous survey about urologists' practice patterns and attitudes towards the use of urethral dilatation in adult women with lower urinary tract complaints. Materials and MethodsAn 8-item questionnaire was mailed to 428 consultant urologists listed as full members of the British Association of Urological Surgeons. The questionnaire focused on assessing the relative indications of performing urethral dilatation by urologists, perceived effectiveness, frequency of using the procedure, the need for repeated dilatation, form of anaesthesia used and the maximum size of dilators to be used. Consultants were asked to state how long it was since they were appointed as consultant urologists. ResultsA total of 176 urologists completed and returned the questionnaire (response rate 42%), of which 171 returns were considered for evaluation (5 consultants reported that they never offer their patients dilatation). The results of the survey are listed in the Appendix.Although 12% of urologists believe urethral stenosis is the only indication for dilatation, it was the most common

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“…[11] Even without supportive scientific evidence as a long-term cure, it is still being regularly practiced by around 69% of urologists as per a recent British survey. [12] Data has suggested that after failure of an initial urethral dilatation, further attempts are less likely to be successful, probably because of worsening and extension of the urethral scarring. It is known that women with voiding dysfunction without a stricture also improve temporarily after dilatation[13] and this along with poor dissemination of available scientific evidence for workup of female voiding dysfunction is the reason why urethral dilatation is still prevalent among grassroot practitioners.…”

Management of recurrent urinary tract infections in women

“…Although UTI was not listed as an indication, many urologists did not feel that dilatation resulted in long-term improvement of most LUTS. 49 There is therefore currently no role for urethral dilatation in the management of uncomplicated rUTIs.…”

Female Urethral Strıcture

“…İnternal üretrotomi büyük ölçüde terkedilmiş olsa da yapılan bir çalışmaya göre üretral dilatasyon, ürologların %69'u tarafından düzenli olarak uygulanmaktadır. 23 Uygulama sonrasında üretral darlığı daha karmaşık hâle getirebilmekle birlikte, dilatasyonun ya da self kateterizasyonun ne kadar süre yapılacağı ve çapının hangi düzeye kadar genilşetileceği de net değildir. Romman ve ark.nın yapmış olduğu 93 hastalık bir çalışmada, 41 Fr'ye kadar üretra dilatasyonu yapılmış ve 46 aylık takipte başarı oranı %49 olarak değerlendirilmiştir.…”