Urethral Stricture - Therapeutic Results and Experiences

Summary:

Endoscopic urethrotomy is widely used in urethral strictures. We retrospectively analyzed 399 patients primarily treated with internal urethrotomy (follow-up 4.6ys; 9 - 192 ms) to look for prognostic features of stricture recurrence. The total group consisted of 357 patients treated at Mainz University between 1977 and 1989 and 42 patients treated at Bonn University between 1979 and 1981 who were eligible for follow-up studies. Recurrent strictures were seen in 96/357 (27 %) and 12/42 (29 %) patients, respectively. Reasons for strictures were TUR-P (23 %/33 %), transurethral catheterization (11 %/7 %) or inflammation (8 %/15 %). Strictures without known cause (idiopathic) were found in 51 % and 45 %, respectively. Complications of urethrotomy occurred in 6.7 %/19.0 %. In both groups the idiopathic strictures showed the best long-term results with a recurrence rate of 20 % and 21 %, respectively. They also had the longest time to recurrence. The shorter the stricture length and postoperative catheterization period (<3 days) the better was the long-term result in both groups. Multiple strictures had the worst prognosis (recurrence rate 42 %). Clean intermittent catheterization for 1 year lowered the recurrence rate from 27 % to 12 %. 37 of 357 patients (10 %) needed reconstructive urethroplasty after multiple internal urethrotomies. The overall primary success rate of open reconstruction was 40 %. The onlay techniques showed better results than tube urethroplasties. In conclusion, internal urethrotomy remains treatment of first choice in all urethral strictures. Patients at high risk for stricture recurrence and patients with more than one treatment failure after urethrotomy should be treated by open urethroplasty, but may often need additional procedures. Clean intermittent catheterization remains an alternative treatment for older patients.

Key words:

Urethral stricture - Internal urethrotomy - Urethroplasty - Long-term follow-up