INTRODUCTION: We analyzed: (1) the effect of internal urethrotomy on objective and subjective measures of bladder function and bladder wall thickness, (2) the stricture recurrence rate, and (3) the effects of urethral and bladder changes on recurrent stricture formation.
METHODS: Between October 2008 and May 2009, 22 male patients with primary urethral strictures (14 membranous, 4 penile, 4 bulbous) were prospectively studied. Strictures were posttraumatic (68.2%), iatrogenic (27.3%), or idiopathic (4.5%). Urethral stricture was incised at the 12 o'clock position with a 21F internal urethrotome, which included a cold knife under direct monitoring. Patients were evaluated 6 and 12 months postoperatively. Statistical analyses included paired-sample t tests with a Bonferonni adjustment (significance at P < .004) and Pearson correlations.
RESULTS: The mean age of the patients was 59.1 (13.7) years. The length of stricture was 6.1 (1.7) mm. The stricture was most prevalent in the membranous urethra (63.6%). Significant improvements were detected in mean International Prostate Symptom Score and peak flow at 6-months and 12-months postoperatively, when compared with baseline (all with P < .001). Mean urethral width and the wall thickness of the empty bladder significantly decreased 6 and 12 months after surgery (all with P < .001). The mean bladder wall thickness of the filled bladder significantly decreased from baseline at 6 months (P < .001) but not at 12 months following surgery (P > .004). Stricture recurrence rates were 13.6% at 6 months and 27.3% at 12 months. All patients were instructed to perform intermittent self dilatation; at the postoperative 6-month and 12-month follow-up, 16 patients (72.7%) and 11 patients (50%), respectively, were using it. There was no significant correlation between stricture recurrence and wall thickness of the empty or filled bladder, bladder capacity, urethral stricture location, stricture length, or the length of the widest segment of the urethra.
CONCLUSIONS: Internal urethrotomy is a successful procedure with rapid effect for management of primary short-segment urethral strictures. Significant changes in the urethra and bladder occur after surgery. However, these changes do not appear to be correlated with stricture recurrence.
Mustafa Aldemir, Evren Isık, Emrah Okulu, Kemal Ener, Önder Kayıgil
Submitted: December 21, 2010
Accepted for Publication: January 26, 2011
KEYWORDS: Urethral stricture; Internal urethrotomy; Urethral and Bladder Changes; Recurrence; Intermittent self-dilatation.
CORRESPONDENCE: Mustafa Aldemir, M.D., Aydinlikevler Mahallesi Arilik Sokak No: 5/5, P.O. Box 06130, Ankara, Turkey ( ).
CITATION: UroToday Int J. 2011 Apr;4(2):art27.
doi:10.3834/uij.1944-5784.2011.04.09