should i go for third urethral dilation

[rkcheng]

i am 80, healthy and expect to live well past 90(my dad was 102 when he died of pneumonia). i have had two turps, last one in 1995. Have had frequent UTI's due probably to strictures and reduced flow rate. Had two dilations that helped somewhat(temporarily) but now UTI's come more frequently. Urologist wants to do a third dilation. I read that dilations create more strictures. So I am wondering if there are other alternatives. I read where urinary stents are sometimes(up to 80%) successful and even if not the stent can be removed. Urethrotomy is the gold standard but I can imagine the pain and suffering involved. Plus, my flow rate is not really that bad as long as i am free of UTI. Should i hold off on the dilation and reconsider stent or other options? Also please recommend a Urologist in the south bay area of LA or ucla or usc, who is capable of the various options.

[el_em_en_oh]

This post is almost 3 years old, so this guy's probably not looking for an answer any more, but I will say that the information you gave is AWESOME.

Great info for anyone with Ureteral Strictures.

One thing that's caught my eye though... I didn't think that the Urethera could have a stricture. I thought that they were prominent in the Ureter.

Urethra = basically, the tube inside your penis.
Ureter = basically, the tube that connects your kidney to your bladder.

So which does the article(s) refer to, and what are YOU referring to?

[axkfgj202]

Urethrotomy is not the gold standard, if long-term success rates are the measure.

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How to Pass the FRCS(Urol)

Q. Describe, in general terms, how you would manage an anterior urethral stricture:

Avoid the so-called ‘reconstructive ladder’ where several urethral dilatations are followed by several optical Urethrotomies and eventually definitive surgery in the form of an Urethroplasty. This sequential process may extend the length and depth of the stricture increasing the complexity and compromising the outcome of Urethroplasty.

Aims of treatment of urethral stricture disease – firstly define the goal of treatment, which essentially is whether the patient wishes his/her stricture to be managed (periodic dilatations or Urethrotomies) or cured (by Urethroplasty).

http://depts.washington.edu/uroweb/print/pdf/urologyNews_howto_06.pdf


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Urethrotomy Has a Much Lower Success Rate Than Previously Reported

Richard Santucci and Lauren Eisenberg
From the Detroit Medical Center and Michigan State College of Osteopathic Medicine, Detroit, Michigan

Urethrotomy is a popular treatment for male urethral strictures. However, the performance characteristics are poor. Success rates were no higher than 9% in this series for first or subsequent urethrotomy during the observation period. Most of the patients in this series will be expected to experience failure with longer followup and the expected long-term success rate from any (1 through 5) urethrotomy approach is 0%. Urethrotomy should be considered a temporizing measure until definitive curative reconstruction can be planned.

THE JOURNAL OF UROLOGY®  Vol. 183, 1859-1862, May 2010
© 2010 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.



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Urethral Stricture Tips

The literature is relatively uniform in stating that the patient who may enjoy success from an internal urethrotomy or dilation with curative intent will have a short segment stricture (1 to 1 1⁄2 cm.), will have relatively superficial spongiofibrosis, and the stricture will be located in the bulbous urethra.

The success rate for internal urethrotomy and dilation for strictures other than in the bulbous urethra is dismally poor.

There is also ample literature which states that repetitive dilation and internal urethrotomy never proceed to cure, but they certainly proceed to spreading the stricture disease, making reconstruction more difficult, and making the results of subsequent reconstruction less than they would have been should the stricture have been addressed initially.

http://www.medicalnewstoday.com/articles/117793.php


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Repeat Urethrotomy and Dilation for Urethral Stricture Disease is neither Clinically Effective Nor Cost-Effective

http://www.urotoday.com/urologic-trauma-and-reconstruction-1345/repeat-urethrotomy-and-dilation-for-urethral-stricture-disease-is-neither-clinically-effective-nor-costeffective-1277.html


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Most urologists in the United States have little experience with urethroplasty surgery. Most urologists erroneously believe that the literature supports a reconstructive surgical ladder for urethral stricture management. Unfamiliarity with the literature and inexperience with urethroplasty surgery have made the use of endoscopic methods inappropriately common.

Adult Anterior Urethral Strictures: A National Practice Patterns Survey of Board Certified Urologists in the United States
THE JOURNAL OF UROLOGY® Vol. 177, 685-690, February 2007
Copyright © 2007 by AMERICAN UROLOGICAL ASSOCIATION


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