Factors Affecting Recurrence Rate of Urethral Stricture Following Internal Urethrotomy

Background: Urethral stricture (post-scarring contraction in the urethral mucosa) is among the most challenging clinical conditions in urology. In Pakistan, Urethral stricture is a high-volume disease and constitutes 4-5% of urology workload (majority of them being in the 3rd to 5th decade of life). Different urethral strictures have different management option depending upon site, size and number of recurrences. OIU is indicated for urethral stricture for small (1.5 cm) bulbar and membranous urethral stricture. However, recurrence of strictures after OIU is quite common (4 to 5%). It has been proposed that duration and size of catheter after OIU effects the recurrence rate. The foremost management choice is internal urethrotomy, but recurrences are common, and many believe that the duration and size of catheterization post internal urethrotomy may affect the recurrence rate.

Objective: To determine the factors affecting recurrence rates of urethral stricture after internal urethrotomy.

Methodology: It was Quasi Experimental Study conducted in Urology ward of Dr. Ziauddin University Hospital, Karachi from 10th March 2020 to 31 december 2021. Total 60 patients were included; all of the patients were divided into four equal groups. All the patients were followed quarterly for 12 months and data was recorded for urinary flow, retention, burning sensation during urination. UFM, Cystoscopy and urethrogram were done once indicated. Symptomatic patients or patients with UFM 15ml/sec were checked for recurrence followed by cystoscopy if needed. The data analysis was obtained using SPSS v. 21.0.

Results: The mean age of the sample stood at 27 (SD ± 4) years (range: 20 to 40) years were enrolled in the study. Urethral stricture disease recurred cumulatively in 24 (40%) patients within 12 months. Mean duration of catheterization was 8.71 ± 1.1 and 2.97 ± 0.91 days in patients with and without recurrences, respectively (p=0.001). Catheter dwell times for ≥7 days was associated with increased recurrence (p=0.039). Of the patients with recurrent strictures, increased catheter diameter was also associated with higher recurrence rates (p=0.041).

Conclusion: After careful consideration, it can be concluded that longer catheter in-dwell time and greater catheter diameter lead to a greater probability of stricture recurrence and hence the indwell time should be limited to ≤ 3 days and the catheter size chosen to be no more than 16Fr.