Direct Vision Internal Urethrotomy in the Management of Urethral Strictures (A Four Year Experience)

Abstract

Direct vision internal urothrotomy is a safe, effective means to treat urethral strictures and bladder neck contractures. Over a period of 4 years, we have treated 225 patients of urethral stricture to find out the aetiology of this disease in the study group and to evaluate the factors effecting the outcome of internal urethrotomy. All patients were evaluated with detailed history, clinical examination, routine urine examination, urine culture if required and retrograde I voiding cystourethrogram to determine the site, number, length and severity of stricture. The majority of strictures in our study were iatrogenic in nature (51%) and were located in bulbous urethra (49%). Urethroscopy was performed and strictures were incised with cold knife at 12 O’clock along the whole length and depth. Following urethrotomy, an indwelling catheter was placed for a variable time depending upon the severity of the disease. Two hundred and five patients were followed up for a period of 6 months to 2 years. Satisfactory voiding was achieved in 78% of all cases. The results of the urethrotomy were better in short strictures and those managed with less period of catheterization. Traumatic and strictures at multiple sites responded poorly to optical internal urethrotomy. The overall complication rate was 9%. It is concluded that internal urethrotomy is a safe technique that should be exercised as a therapeutic trial before a final decision to perform definite urethroplasty.