OUTPATIENT TREATMENT FOR MALE URETHRAL STRICTURES - DILATATION VERSUSINTERNAL URETHROTOMY

Male patients with proven urethral strictures (total 210) were prospec tively randomised to undergo either dilatation (106 patients) or inter nal urethrotomy (104 patients) as an outpatient procedure under local anaesthesia. The incidence of complications or failure during the perf ormance of the procedure did not differ significantly between the two treatment groups. Complications or failure in performing urethral dila tation were significantly more common in patients who presented with r etention or complications compared with symptoms only, and in those wi th a positive compared with negative urine cultures. Complications or failure in performing internal urethrotomy were significantly more com mon in patients with a positive than with a negative urine culture, an d long (> 2 cm) rather than short (< 2 cm) strictures, whereas the dif ference approached significance for patients with multiple rather than single strictures (P = 0.06). Failure alone in the performance of int ernal urethrotomy was significantly more common in patients with traum a compared with urethritis as aetiology, and in those without previous structure treatment. With a mean follow-up of 15 months the cumulativ e percentage of recurrent urethral strictures did not differ significa ntly between the two treatment groups. We conclude that urethral dilat ation and optical internal urethrotomy under local anaesthesia are equ ally successful as initial outpatient treatment. With regard to succes sful performance of the procedure itself, multiple, longer (> 2 cm), p ost-traumatic, and previously untreated strictures are better managed with dilatation, whereas patients with complications or retention are better managed with internal urethrotomy. A positive urine culture is associated with a higher complication and failure rate in the performa nce of both procedures.