L A Levine1, B P Engebrecht. 1. Department of Urology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
Abstract
PURPOSE: We determined the efficacy of adjuvant home balloon self-dilation as an alternative to office dilation and to reduce the likelihood of recurrence in patients with recalcitrant urethral strictures. MATERIALS AND METHODS: A total of 31 men participated in a urethral self-dilating protocol following phallic construction, urethroplasty or visual internal urethrotomy, or as conservative management in 2 nonoperative candidates. Uroflow data and subjective information obtained by blinded questionnaire were reviewed. RESULTS: The 31 patients were followed for a mean of 18.7 months (range 3 to 45) after initial balloon dilation, and 25 (81%) were available for followup interviews. Of the 25 patients 24 (96%) found no difficulty in learning the technique and 21 (84%) thought they received adequate training with 1 office visit. Most patients noted improvement in voiding with balloon dilation, and peak uroflowmetry rates were preserved or improvement with long-term followup. Six patients (19%) complained of discomfort with balloon placement, 3 (10%) noticed minor bleeding with dilation and 4 (13%) had urinary tract infections during followup. Following visual internal urethrotomy, no stricture recurrences were noted in 9 patients. Strictures recurred in 2 of 13 (15%) urethroplasty patients following balloon dilation. After radial forearm free flap phallic construction, a technique known to have a high re-stricture rate, 5 of 7 patients (71%) had recurrent urethral stricture. CONCLUSIONS: Preliminary results indicate that adjuvant outpatient urethral self-dilation following surgical correction of urethral strictures in patients at high risk for recurrence is inexpensive and safe, as well as a potentially effective option in reducing stricture recurrence and maintaining urethral patency.
PURPOSE: We determined the efficacy of adjuvant home balloon self-dilation as an alternative to office dilation and to reduce the likelihood of recurrence in patients with recalcitrant urethral strictures. MATERIALS AND METHODS: A total of 31 men participated in a urethral self-dilating protocol following phallic construction, urethroplasty or visual internal urethrotomy, or as conservative management in 2 nonoperative candidates. Uroflow data and subjective information obtained by blinded questionnaire were reviewed. RESULTS: The 31 patients were followed for a mean of 18.7 months (range 3 to 45) after initial balloon dilation, and 25 (81%) were available for followup interviews. Of the 25 patients 24 (96%) found no difficulty in learning the technique and 21 (84%) thought they received adequate training with 1 office visit. Most patients noted improvement in voiding with balloon dilation, and peak uroflowmetry rates were preserved or improvement with long-term followup. Six patients (19%) complained of discomfort with balloon placement, 3 (10%) noticed minor bleeding with dilation and 4 (13%) had urinary tract infections during followup. Following visual internal urethrotomy, no stricture recurrences were noted in 9 patients. Strictures recurred in 2 of 13 (15%) urethroplasty patients following balloon dilation. After radial forearm free flap phallic construction, a technique known to have a high re-stricture rate, 5 of 7 patients (71%) had recurrent urethral stricture. CONCLUSIONS: Preliminary results indicate that adjuvant outpatient urethral self-dilation following surgical correction of urethral strictures in patients at high risk for recurrence is inexpensive and safe, as well as a potentially effective option in reducing stricture recurrence and maintaining urethral patency.