UroToday - Drs. Smith, Ferlise and Rovner from Philadelphia, PA and Charleston, SC retrospectively reviewed their series of seven women with urethral strictures who were managed by urethral dilation followed by clean intermittent catheterization (CISC). These seven women had a mean age of 41 years (range 22-67). All women had a fixed urethral narrowing of < 14F which prevented instrumentation. Women who had previous pelvic radiation, gynecologic, bladder or urethral cancer, history of anti-incontinence surgery, primary bladder neck obstruction and/or meatal stenosis were excluded. All women were evaluated with a video urodynamic study or voiding cystourethrogram and urodynamics.

In these women, at the time of initial cystoscopy, the urethra was progressively dilated to ? 30 F using sounds. This was tolerated well by all of the women. All strictures were biopsied to rule out malignancy. A foley catheter was left in place for 1-7 days at which time the patients returned to the office to be taught CISC with an 18-20 F catheter by a nurse specialist. Women with no recurrence at ? 6 months were given the option to decrease CISC to every other day and then once weekly. Women were evaluated every 3-6 months. Surgical urethral dilation was repeated if the stricture recurred. Three women required repeat dilation (range 2-4 dilations). The recurrences occurred in women who were not initially compliant with their CISC.

The mean follow up for the patients was 21 months (range 6-34). After treatment women had an improvement in their AUA symptom scores and there was no exacerbation in stress urinary incontinence symptoms in any of the patients and no development of de novo stress urinary incontinence.

The authors concluded that urethral dilation and CISC is an effective therapy in managing women with urethral strictures as long as the patient is compliant with CISC. This certainly appears to be a good alternative to major urethral reconstructive therapy in those who wish to avoid more invasive surgery, as it is effective and has few complications.

By M. Louis Moy, M.D.

BJU Int 2006; 98: 96-99
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