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Self urethral dilatation still a viable option

27-08-2010      2289 views

This study was undertaken to evaluate the effectiveness of self urethral dilatation (SUD) and how it affected patients’ quality of life. Besides, we assessed its cost-effectiveness and clinical improvement towards their urine outflow.

Patients and methods
This is a retrospective review of patients who underwent SUD for urethral stricture disease from September 2000 to July 2009. During the study period, patients were referred by the urologist to our nursing unit for the education of SUD. All patients and their caregivers, if applicable, were taught the technique on SUD on a one-to-one basis.

The patients were then monitored regularly in our nurse-led clinic. Some of the patients also had cystoscopy for follow-up of the stricture, depending on the arrangement of referring urologists.

In the course of the study
The study enrolled 35 patients, 25 men and 10 women, using SUD for the management of urethral strictures and were included in this review. The mean age 65.3 years old (ranges from 19-87), with majority of patients in the age group of 70-79 years old. 77% of study subjects presented with weak stream of urine and the remaining 23% presented with acute retention of urine.

The locations of the stricture were listed with the majority occurring at either the meatal (31%) or the bulbar (29%) region. Other sites included penile urethra (20%), bladder neck (14%), membranous 23%) and anastomotic site after radical prostatectomy (3%).

The most common attributed aetiology for the stricture were previous surgery, including transurethral resection of prostate (31%), radical prostatectomy (14%), vulvectomy (6%). Treatment prior to SUD was rather diverse, including urethral dilatation (52%), internal urethrotomy(13%) and bladder neck incision (6%).

After performing a series of SUD, there was a significant reduction in undergoing internal urethrotomy and rigid cystoscopy with dilatation. The comparison on flow rate before and one-month after SUD was conducted. As the follow-up schedule among the population varied, the data nearest to one month was used. The mean follow up after their first visit was 3.8 weeks with S.D. 1.4 week. The pre-SUD maximal flow rate was 13.4 ml/s. The same parameters for one-month post-SUD were 18.9ml/s.

There was a significant improvement in both the total voided volume and the maximal flow rate before and after SUD.

The reported complication was minimal. Only one case reported symptomatic urinary tract infection; after the treatment with antibiotics the symptom subsided. There were 25 questionnaires returned for analysis. 16 (64%) patients reported that they have good compliance to the SUD instruction. 14 (56%) patients believed that they had only mild difficulties or even no difficulties when performing SUD, while only 16% of them reported that they have severe difficulties with SUD.

The majority of patients (64%) tolerated the procedure well and only 8% of them felt that SUD was unacceptable. 18 (72%) patients claimed performing SUD had a good impact on their social life.

A positive effect
In dealing with superficial urethral stricture, urologists can consider offering a trial of SUD after a single urethral dilatation or operation so as to reduce the recurrence rate. SUD can also serve as an alternative treatment option when patient cannot tolerate reconstructive surgery or urethroplasty due to old age or unwillingness.

Self urethral dilatation is still a viable treatment option for urethral stricture and was well tolerated by most of the patients and resulted in a good impact on their quality of life.
W.Y. Yung, RN
Lithotripsy and Uroinvestigation Centre
Dept. of Surgery Prince of Wales
Hospital / the Chinese University of Hong Kong
Hong Kong (CN)

Article from European Urology Today, volume 22, No. 3

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