URETHRAL STRICTURE - THERAPEUTIC RESULTS AND EXPERIENCES

Endoscopic urethrotomy is widely used in urethral strictures. We retro spectively analyzed 399 patients primarily treated with internal ureth rotomy (follow-up 4.6 ys; 9-192 ms) to look for prognostic features of stricture recurrence. The total group consisted of 357 patients treat ed at Mainz University between 1977 and 1989 and 42 patients treated a t Bonn University between 1979 and 1981 who were eligible for follow-u p studies. Recurrent strictures were seen in 96/357 (27%) and 12/42 (2 9%) patients, respectively. Reasons for strictures were TUR-P (23%/33% ), transurethral catheterization (11%/7%) or inflammation (8%/15%). St rictures without known cause (idiopathic) were found in 51% and 45%, r espectively. Complications of urethrotomy occurred in 6.7%/19.0%. In b oth groups the idiopathic strictures showed the best long-term results with a recurrence rate of 20% and 21%, respectively, They also had th e longest time to recurrence. The shorter the stricture length and pos toperative catheterization period (< 3 days) the better was the long-t erm result in both groups. Multiple strictures had the worst prognosis (recurrence rate 42%). Clean intermittent catheterization for 1 year lowered the recurrence rate from 27% to 12%. 37 of 357 patients (10%) needed reconstructive urethroplasty after multiple internal urethrotom ies. The overall primary success rate of open reconstruction was 40%. The onlay techniques showed better results than tube urethroplasties, In conclusion, internal urethrotomy remains treatment of first choice in all urethral strictures. Patients at high risk for stricture recurr ence and patients with more than one treatment failure after urethroto my should be treated by open urethroplasty, but may often need additio nal procedures. Clean intermittent catheterization remains an alternat ive treatment for older patients.