ADJUVANT HOME URETHRAL BALLOON DILATION FOR THE RECALCITRANT URETHRALSTRICTURE

Purpose: We determined the efficacy of adjuvant home balloon self-dila tion as an alternative to office dilation and to reduce the likelihood of recurrence in patients with recalcitrant urethral strictures. Mate rials and Methods: A total of 31 men participated in a urethral self-d ilating protocol following phallic construction, urethroplasty or visu al internal urethrotomy, or as conservative management in 2 nonoperati ve candidates. Uroflow data and subjective information obtained by bli nded questionnaire were reviewed. Results: The 31 patients were follow ed for a mean of 18.7 months (range 3 to 45) after initial balloon dil ation, 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. Mo st patients noted improvement in voiding with balloon dilation, and pe ak uroflowmetry rates mere preserved or improved with long-term follow up, 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 urethroto my, no stricture recurrences were noted in 9 patients. Strictures recu rred in 2 of 13 (15%) urethroplasty patients following balloon dilatio n. After radial forearm free flap phallic construction, a technique kn own to have a high re-stricture rate, 5 of 7 patients (71%) had recurr ent urethral stricture. Conclusions: Preliminary results indicate that adjuvant outpatient urethral self-dilation following surgical correct ion of urethral strictures in patients at high risk for recurrence is inexpensive and safe, as well as a potentially effective option in red ucing stricture recurrence and maintaining urethral patency.