ROLE OF INTERMITTENT SELF DILATATION IN THE PREVENTION OF URETHRAL STRICTURE RECURRENCE AFTER DIRECT VISUAL INTERNAL URETHROTOMY: A RANDOMIZED CONTROLLED TRIAL


S. K. Singh, C. S. Agrawal, S Agrawal, N Thapa, R. S. Shah

ABSTRACT

Urethral stricture refers to scarring process involving corpus spongiosum. Strictures may be from: prostatectomy, perineal trauma, urethral catheterization, idiopathic/unknown, urethritis, and cystoscopy. Direct visual internal urethrotomy followed by intermittent self-dilatation is the most commonly performed intervention for urethral stricture. The aim of current study is to compare the efficacy of Direct Visual Internal Urethrotomy followed by Intermittent Self Dilatation versus No Dilatation. A total of 15 patients in each group were included. Groups were the subjects with urethral stricture with no dilatation and with intermittent self- dilatation. Retrograde urethrogram and micturating cystourethrogram were performed to evaluate the site and size of Stricture. Uroflowmetry was performed before the start of treatment to record the maximum flow rate. On the result of urethrocystoscopy (free passage of the 20F scope to the bladder) a diagnosis of recurrence was determined. Group comparison of efficacy was assessed by chi square test and Mann Whitney U test. The IPSS scores were 25.27 ± 5.57 in intervention group and 22.53 ± 5.35 in control group. Uroflowmetry score was 6.20 ± 1.89 in intervention group and 5.73 ± 1.94 in control group. Stricture size was 9.67 ± 3.65mm in intervention group and 8.47 ± 4.56 mm in control group. Analyzing the stricture at 6 months, in the intervention group (n=15), none had stricture whereas in control group, 3 out of 14 had stricture. Analyzing the stricture at 6 months per Intention to treat, in the intervention group (n=15), none had stricture whereas in control group, 3 out of 15(20%) had stricture. Thus the study showed that recurrence of stricture was markedly decreased over the six month of follow up period in the intermittent self-dilatation group.

Keywords: Direct Visual Internal Urethrotomy, micturating cystourethrogram, urethral strictures, intermittent self-dilatation, Uroflowmetry