Role of Intermittent Self Dilatation in the Prevention of Urethral Stricture Recurrence After Direct Visual Internal Urethrotomy: A Randomized Controlled Trial

Abstract

INTRODUCTIONUrethral stricture refers to anterior urethral disease, a scarring process involving the spongy erectile tissue of the corpus spongiosum, also referred to as spongiofibrosis 1 . 80% of strictures that are secondary to instrumentation occur at the membranous urethra. The other 20% generally occur at the penoscrotal junction. A study done by Palminteri et al 2 on 1439 patients with urethral stricture showed that 675 patients (46.9%) had stricture in the bulbar urethra and very few had penile plus bulbar urethral stricture. Before the 21 st century, the majority of urethral strictures resulted from urethritis or sexually transmitted diseases. Post inflammatory strictures are seldom seen in todays developed world. Instead, urethral strictures may be from: prostatectomy, perineal trauma, urethral catheterization, idiopathic/unknown, TUR, hypospadias, pelvic fracture, urethritis, cystoscopy and lichen sclerosis 3 . Kashefi et al 4demonstrated that an estimated 3.2 urethral injures per 1000 inpatients were secondary to traumatic catheterizations. Stein et al 5 in retrospective study involving 2589 patients showed that the most common cause for stricture was idiopathic at 41.3% followed by iatrogenic at 35%. In the other study done by Stein et al 5 in India the most common cause was traumatic at 36%. In patients younger than age 45, hypospadias surgery, idiopathic, lichen sclerosis and pelvic fracture are among the most common causes of urethral strictures. 3Urethral stricture remains complicated surgical problem for mankind since ancient time and thus the treatment remains to evolve. In the history, the earliest recorded attempt to treat the stricture was metal dilator. Later on it was replaced by blind internal urethrotome by Civiale and Ottis in 18 th century but had not gained much popularity because of their complications and poor result. Since then, the practice of dilatation has not changed significantly. DVIU was popularized after the initial report of Sachse in 1972. In the 1980s, the concept of intermittent self-dilatation (ISD) following DVIU took shape in order to decrease stricture recurrence.