Treatment of male urethral strictures - possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty
Date
2012-08
Authors
Heyns, C. F.
Van der Merwe, J.
Basson, J.
Van der Merwe, A.
Journal Title
Journal ISSN
Volume Title
Publisher
Centre of African Studies, University of Cape Town
Abstract
Objective. To investigate the possible reasons for repeated
urethral dilatation or optical internal urethrotomy rather than
urethroplasty in the treatment of male urethral strictures.
Patients and methods. Men referred to the stricture clinic of
our institution during the period April 2007 - March 2008 were
reviewed and the operative urological procedures performed in
the same period were analysed. Statistical analysis was performed
using Student’s t-test and Fisher’s exact test (p<0.05 statistically
significant).
Results. The mean age of the 125 men was 49.9 years (range
12.8 - 93.4 years). Previous stricture treatment had been given
1 - 2, 3 - 4 and 5 - 6 times in 52%, 32% and 12% of patients,
respectively (4% had not undergone treatment). In these
groups, previous treatment was dilatation in 70%, 76% and
72%, urethrotomy in 26%, 15% and 28%, and urethroplasty
in 4%, 9% and 0, respectively. The group with 5 - 6 compared
with 1 - 2 previous treatments was significantly older (mean age
60.2 v. 46.6 years) and had a significantly greater proportion
with underlying co-morbidities (80% v. 52%). The group that
had undergone urethroplasty compared with 5 - 6 repeated
dilatations or urethrotomies was significantly younger (mean age
48.2 v. 60.2 years) with a lower prevalence of co-morbidities (47%
v. 80%). During the study period urethroplasty was performed in
16 (2%) of 821 inpatients, whereas 55 men were seen who had
undergone ≥3 previous procedures, indicating that urethroplasty
was performed in less than one-third of cases in which it would
have been the optimal treatment. Owing to limited theatre time,
procedures indicated for malignancy, urolithiasis, renal failure
and congenital anomalies were performed more often than
urethroplasty.
Conclusions. Factors that possibly influenced the decision
to perform repeated urethrotomy or dilatation instead of
urethroplasty were limited theatre time, increased patient age
and the presence of underlying co-morbidities.
Description
Keywords
Uterus -- Dilatation, Urethrotomy
Citation
Heyns, C. F. et al. 2012. Treatment of male urethral strictures - possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty. South African Journal of Surgery, 50(3), 82-87