Introduction and Objectives
Urethral strictures (US), impassable in a retrograde fashion, impose a special problem to the urologist. Open urethroplasty is usually required. Our goal was to evaluate the results of bipolar endoscopic procedures (BEP) in such cases.
Material and Methods
Between November 1999 and January 2009, we evaluated 42 patients with complicated urethral strictures (5 penian, 24 bulbar and 13 membranous) which have been treated by BEP. 28 cases had perineal urethral trauma, 12 cases had recurrent inflammatory stenosis and 2 cases had previous prostatic surgery. All cases underwent previous suprapubic cystostomy. In 34 cases, we used the “cut-to-light” technique (flexible cystoscope introduced antegradely), and in 8 cases the incision was made over the guidewire placed in an antegrade manner (23 cases with cold-knife and 19 cases with Nd:YAG laser). The mean follow-up period was 58 months.
Results
In 39/42 patients (92.9%), the procedure was successfully carried out. However, the global recurrence rate was 53.8% (21/39 cases), imposing further endoscopic management in order to maintain urethral patency. Regarding the location of the stricture, the recurrence rate was: 50% for penile, 47.8% for bulbar and 66.7% for membranous urethra. The recurrence rate was 65.2% (15/21 cases) for patients treated by cold-knife incision by comparison to 33.3% (6/18 cases) in those treated with Nd:YAG laser. The mean recurrence period was 11 months.
Conclusions
BEP, performed especially by the “cut-to-light technique”, represents an alternative for complete urethral stenosis. This method may constitute the first-choice treatment alternative, especially for severe strictures of the bulbar urethra.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
