place of direct vision internal urethrotomy in the management of urethral strictures

ABSTRACT

Direct vision internal urethrotomy is a safe and effective means to treat urethral strictures only on proper choice of the case, otherwise serious complications can occur. During a 2-year period urethral strictures in 60 patients were treated by cold knife urethrotomy with a success rate of 95% with 6 months of follow up, although a longer interval may be necessary for a more accurate record. This high rate of success can be attributed to two main factors, the proper choice of case and some technical points. The criteria of the urethral stricture we found ideal for internal urethrotomy are 1-Its length is within 1 cm. 2-Single. 3-It must have a visible lumen through which a guide catheter can be passed. 4-Not complicated by severe periurethral fibrosis [as in post traumatic cases] or false passages [from prior dilatation]. The technical points, we found them of importance are 1-Proper antimicrobial therapy according to culture and sensitivity of urine, to be started one day before the procedure and continued for one week after. 2-Calibration of the urethrotomy up to 24 or 26 ch., because the appearance of the incised stricture is not sufficient to judge the adequacy of the procedure. 3-20 F Silicon catheter for one week after urethrotomy. 4-Corticosteroids [systemic] for one month after the procedure