📃 Paper Title: Internal Urethrotomy Versus Dilation as Treatment for Male Urethral Strictures: A Prospective, Randomized Comparison
🧍 Author: Steenkamp
🕒 Year: 1997
📚 Journal: Journal of Clinical Urology
🌎 Country: South Africa
ㅤContext to the study:
Can you tell me about a study that did not show a difference in efficacy between dilatation and urethrotomy for male urethral strictures?
ㅤ✅ Take-home message of study:
Author conclusions:
no difference in efficacy between dilatation and urethrotomy
Author recommendations:
strictures <2cm should be treated with either dilatation or urethrotomy
Strictures >4cm should be treated with primary urethroplasty
Strictures 2-4cm should be offered a trial of dilatation or urethrotomy.
ㅤ Prospective randomised study
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Study participants:
Participants
Inclusion: Men with proved urethral strictures
210 men randomised to filiform dilation (n=106) or urethrotomy (n=104)
preop evaluation with MSU, urethrography
Procedures
IV 80mg gentamicin cover, and urethral lidocaine jelly.
Dilatation: dilatation to 24Fr over Philips filiform leader passed with 19Fr rigid cystoscope with serial filiform followers.
Urethrotomy: 5Fr whistle tip catheter passed, followed by optical internal sachse urethrotomy at 12 o'clock
Post op 18Fr silicone catheter for 4 days.
Follow up
3,6,9,12,24,36,48 months. Urethroscopy and attempt at 16Fr cathterisation. Recurring strictures treated with repeated primary procedure.
Urethroplasty performed in patients with >3 recurrent strictures within 1 year.
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Key study outcomes:
Mean follow up 15.4 months dilatation group and 14.4 months in urethrotomy group.
Complication and failure rate did not differ significantly between groups.
Recurrence rate was 10% higher at 48 months in the dilatation group but this did not reach significance.
Rate of recurrence at 12 months overall:
40% for strictures <2cm
50% for strictures 2-4cm (increasing to 75% by 48months)
80% for strictures >4cm
For each 1cm increase in stricture length, risk of stricture recurrence increased by 1.22
No statistically significant effect of aetiology, number or position of stricture on recurrence rates.
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Study Limitations:
Single surgeon single centre study.
No subanalysis on stricture calibre
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