P N Dogra1, M Aron, T P Rajeev. 1. Department of Urology, All India Institute of Medical Sciences, New Delhi.
Abstract
PURPOSE: We studied the safety and efficacy of core through urethrotomy with the neodymium (Nd):YAG laser for posttraumatic obliterative strictures of the bulbomembranous urethra. MATERIALS AND METHODS: Eight patients a mean of 27.5 years old with posttraumatic (motor vehicle accidents) obliterative strictures of the bulbomembranous urethra were treated from May to December 1997. Laser treatment selection criteria were stricture length 2.0 cm. or less, good alignment between the urethral ends and no history of rectal injury or erectile dysfunction. All patients underwent core through urethrotomy with the Nd:YAG contact laser delivered with the 600 micro bare fiber at 15 to 25 W. The urethrotomy was guided only by a metal sound introduced through the suprapubic tract. RESULTS: Blood loss was negligible and excellent visualization was maintained throughout the procedure. Operating time ranged from 45 to 70 minutes. There were no perioperative complications. Hospital stay was 24 hours in the first case and 6 to 8 hours in subsequent cases. All patients returned to work within 5 days. Urethroscopy was performed 4 and 12 weeks after catheter removal in all patients. Only 1 patient required repeat internal urethrotomy. Voiding cystourethrography revealed a stricture-free urethra in 7 cases. At last followup 7 to 14 months (mean 10.25) after the procedure mean maximum flow rate was 18.6 ml. per second (range 16.5 to 22.4) in the patients who were stricture-free and 11.8 ml. per second in 1 with recurrent stricture. CONCLUSIONS: Core through urethrotomy with the contact Nd:YAG laser seems to be a safe and effective treatment option for select strictures. The hospital stay is remarkably short and complications are negligible. Re-stricture rates are likely to be low but more experience and longer follow-up are needed.
PURPOSE: We studied the safety and efficacy of core through urethrotomy with the neodymium (Nd):YAG laser for posttraumatic obliterative strictures of the bulbomembranous urethra. MATERIALS AND METHODS: Eight patients a mean of 27.5 years old with posttraumatic (motor vehicle accidents) obliterative strictures of the bulbomembranous urethra were treated from May to December 1997. Laser treatment selection criteria were stricture length 2.0 cm. or less, good alignment between the urethral ends and no history of rectal injury or erectile dysfunction. All patients underwent core through urethrotomy with the Nd:YAG contact laser delivered with the 600 micro bare fiber at 15 to 25 W. The urethrotomy was guided only by a metal sound introduced through the suprapubic tract. RESULTS: Blood loss was negligible and excellent visualization was maintained throughout the procedure. Operating time ranged from 45 to 70 minutes. There were no perioperative complications. Hospital stay was 24 hours in the first case and 6 to 8 hours in subsequent cases. All patients returned to work within 5 days. Urethroscopy was performed 4 and 12 weeks after catheter removal in all patients. Only 1 patient required repeat internal urethrotomy. Voiding cystourethrography revealed a stricture-free urethra in 7 cases. At last followup 7 to 14 months (mean 10.25) after the procedure mean maximum flow rate was 18.6 ml. per second (range 16.5 to 22.4) in the patients who were stricture-free and 11.8 ml. per second in 1 with recurrent stricture. CONCLUSIONS: Core through urethrotomy with the contact Nd:YAG laser seems to be a safe and effective treatment option for select strictures. The hospital stay is remarkably short and complications are negligible. Re-stricture rates are likely to be low but more experience and longer follow-up are needed.