TREATMENT OF MALE URETHRAL STRICTURES - IS REPEATED DILATION OR INTERNAL URETHROTOMY USEFUL

Purpose: We evaluate the efficacy of repeated dilation or urethrotomy as treatment of male urethral strictures. Materials and Methods: Betwe en January 1991 and January 1994, 210 men with proved urethral strictu res were prospectively randomized to undergo filiform dilation (106) o r internal urethrotomy (104). Followup was scheduled for 3, 6, 9, 12, 24, 36 and 48 months. Dilation or internal urethrotomy was repeated at the first and second stricture recurrence. The Kaplan-Meier method wa s used to estimate survivor function for the treatment methods (surviv al time being the time to first stricture recurrence) an? the log rank test was used to compare the efficacy of different treatments. Result s: Followup (mean 24 months, range 2 to 63) was available in 163 patie nts (78%). After a single dilation or urethrotomy not followed by re-s tricturing at 3 months, the estimated stricture-free rate was 55 to 60 % at 24 months and 50 to 60% at 48 months. After a second dilation or urethrotomy for stricture recurrence at 3 months the stricture-free ra te was 30 to 50% at 24 months and 0 to 40% at 48 months. After a third dilation or urethrotomy for stricture recurrence at 3 and 6 months th e stricture-free rate at 24 months was 0 (p < 0.0001). Conclusions: Di lation and internal urethrotomy are useful in a select group (approxim ately 70% of all patients) who are stricture-free at 3 months, and of whom 50 to 60% will remain stricture-free up to 48 months. A second di lation or urethrotomy for early stricture recurrence (at 3 months) is of limited value in the short term (24 months) but of no value in the long term (48 months), whereas a third repeated dilation or urethrotom y is of no value.