DIRECT VISION INTERNAL URETHROTOMY (DVIU) AND REGULAR CLEAN SELF INTERMITTENT CATHETERIZATION(CSIC) FOR SHORT BULBAR URETHRAL STRICTURES: A DURABLE SOLUTION

Authors

  • Hassan Raza Asghar
  • Manzoor Ahmed Malik
  • Muhammad Adil Chaudhary
  • Mahboob Alam Chishti
  • Zulfiqar Saleem
  • Aleena Ahmed Khan

DOI:

https://doi.org/10.59058/jaimc.v20i2.31

Keywords:

Clean Self-Intermittent Catheterization, Direct Vision Internal Urethrotomy, Recurrence, Urethral Strictures

Abstract

Background: To evaluate durability of DVIU results and recurrence of stricture if the CSIC was done regularly up to one year and weekly thereafter.

Methods: This retrospective study was conducted in the Department of Urology at tertiary care teaching hospital of Avicenna medical college Lahore Pakistan. Files of all patients operated between January 2017 and July 2021 for single bulbar urethral strictures of less than 1-1.5cm size in length, iatrogenic, idiopathic, traumatic or inflammatory origins were evaluated. Patient with multiple or complicated strictures of post urethroplasty, post hypospadias repair, previous radiation or multiple DVIU were excluded from the study. Data analysis of all patients who were on CSIC following direct vision internal urethrotomy were evaluated at 3,6,12 and 24 months.

Results: Mean age of patients was 41.13 years with range between 26-74 years.Most Common cause of urethral strictures were idiopathic 66(58.92%) followed by iatrogenic 27(24.11%) causes. After 24 months of follow up 95 (84.82%) patients maintained urethral caliber up to 16 Fr. Failure or recurrence was found in 17 (15.18%) patients who required intervention.

Conclusion: Direct vision internal urethrotomy (DVIU) with regular clean intermittent self-catheterization (CSIC)was found to have a good success rate in bulbourethral strictures up to 1cm in selected patients.

References

Stein MJ, Desouza RA. Anterior urethral stricture review. TranslAndrol Urol. 2013;2(1):32–38. Avail- able from: https: //dx.doi.org/10.3978/j.issn.2223- 4683. 2012.11.05.

Alwaal A, Blaschko SD, Mcaninch JW, Breyer BN. Epidemiology of urethral strictures. Transl Androl Urol. 2014;3(2):209– 213. Available from: https:// dx. doi.org/10.3978/j.issn.22234683.2014.04.07.

Bergamin PA, Kiosoglous AJ. Surgical management of recurrent urinary tract infections: are view. Transl Androl Urol. 2017;6(S2):S153–S162. Available from: https://dx.doi.org/10. 21037/tau.2017.06.17.

Pal D, Kumar S, Ghosh B. Direct visual internal ureth- rotomy: Is it a durable treatment option? Urol Ann. 2017;9(1):18–18. Available from: https:// dx. doi. org/10.4103/0974-7796.198835

DubeyD. The current role of direct vision internal urethrotomy and self-catheterization for anterior urethral strictures. Indian J Urol. 2011; 27(3): 392–

Available from: https://doi.org/10. 4103/0970- 1591.85445.

Lawrence WT, MacDonagh RP. Treatment of Urethral Stricture Disease by Internal Urethrotomy followed by Intermittent ‘Low-Friction’ Self-Catheterization: Preliminary Communication. JROYSOCMED. 1988; 81(3):136–139. Available from: https:// dx.doi.org/ 10.1177/014107688808100306.

Zehri AA, Ather MH, Afshan Q. Predictors of recur- rence of urethral stricture disease following optical urethrotomy. Int J Surg . 2009;7(4):361–364. Available from: https://dx.doi.org/10.1016/j.ijsu.2009. 05. 010.

KjaergaardB, WalterS, BartholinJ, AndersenJT, NohrS, BeckH, etal. Prevention of urethral stricture recurrence using clean intermittent self-catheterization. Br J Urol. 1994;73(6):692– 695. Available from: https:// dx. doi.org/10.1111/j.1464-410x. 1994.tb07558.x.

Roosen JU. Self-Catheterization after Urethrotomy. Urol Int. 1993;50(2):90–92. Available from: https:// dx.doi.org/10.1159/ 000282459.

Lauritzen M, Greis G, Sandberg A, Wedren H, Öjdeby G, Henningsohn L. Intermittent self-dilatation after internal urethrotomy for primary urethral strictures: A case–control study. Scand J UrolNephrol. 2009; 43(3):220–225. Available from: https:// dx.doi.org/ 10.1080/00365590902835593.

Tunc M, Tefekli A, Kadioglu A, Esen T, Uluocak N, Aras N. Aprospective, randomized protocol to examine the efficacy of post internal urethrotomy dilations for recurrent bulbo membranous urethral strictures. Uro. 2002;60(2):239–244. Available from: https:// dx. doi. org/10.1016/s0090-4295(02)01737-5

Jackson MJ, Veeratterapillay R, Harding CK, Dorkin TJ. Intermittent self-dilatation for urethral stricture disease in males. Cochrane Database Syst Rev. 2014; 19(12):10258– 10258. Available from: https:// doi. org/ 10.1002/14651858. cd010258.pub2.

Ivaz SL, Veeratterapillay R, Jackson MJ, Harding CK, Dorkin TJ, Andrich DE, et al. Intermittent self-dilata- tion for urethral stricture disease in males: A systematic review and metaanalysis. Neurourol Urodyn. 2016; 35(7):759–763. Available from:https:// dx.doi.org/ 10.1002/nau.22803

Pansadoro V, Emiliozzi P. Internal Urethrotomy in the Management of Anterior Urethral Strictures: Long- Term Followup. Jurol. 1996; 156(1): 73–75. Available from: https://dx.doi.org/ 10.1016/s0022-5347(01) 7865942-1.

Holm-Nielsen A, Schultz A, Møller-Pedersen V. Direct Vision Internal Urethrotamy. ACritical Review of 365 Operations. Br J Urol. 1984;56(3):308–312. Available from: https://dx.doi. org/10.1111/j.1464- 410x.1984.tb05393.x.

Greenwell TJ, Castle C, Andrich DE, MacDonald JT, Nicol DL, Mundy AR. Repeat Urethrotomy and Dila- tion for the Treatment of Urethral Stricture Are neither Clinically Effectiven or Cost Effective. J Urol. 2004; 172(1):275–277. Available from: https:// dx.doi.org/ 10.1097/01.ju.0000132156.76403.8f.

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Published

09-01-2023

How to Cite

Hassan Raza Asghar, Manzoor Ahmed Malik, Muhammad Adil Chaudhary, Mahboob Alam Chishti, Zulfiqar Saleem, & Aleena Ahmed Khan. (2023). DIRECT VISION INTERNAL URETHROTOMY (DVIU) AND REGULAR CLEAN SELF INTERMITTENT CATHETERIZATION(CSIC) FOR SHORT BULBAR URETHRAL STRICTURES: A DURABLE SOLUTION. JAIMC: Journal of Allama Iqbal Medical College, 20(2). https://doi.org/10.59058/jaimc.v20i2.31