Saavedra-Briones DV, Merayo-Chalico CE, Sánchez-Turati G, Cantellano-Orozco M, Shuck-Bello C, Camarena-Reynoso HR, Fulda-Graue S, Santana-Ríos Z, Pérez-Becerra R, Urdiales-Ortiz A, Mata-Miranda M, Morales-Montor J, Pacheco-Gahbler C, Calderón-Ferro F

Language: Spanish
References: 16
Page: 153-158
PDF size: 153.38 Kb.

ABSTRACT

Objective: To evaluate long-term results of internal urethrotomy according to surgical technique at the Dr. Manuel Gea González General Hospital.
Materials and methods: From January 2000 to August 2008 a total of 342 patients underwent internal urethrotomy (IU) for symptomatic urethral stricture. Analyzing stricture characteristics, patients were divided into 2 groups with 2 subgroups in each main group. Group 1 was made up of patients who had undergone IU with the Sachse technique. Group 2 was made up of patients having undergone IU with three incisions: at the 12, 9 and 3 o’clock positions. Subgroup A had stricture smaller than 1 cm in length and Subgroup B had stricture larger than 1 cm and up to 2 cm in length.
Results: Sixty-three patients were included in the study. Mean age was 58 years (21-86 year range). Stricture etiology was secondary to transurethral catheter placement in 35 cases (56%), transurethral resection of the prostate (TURP) in 15 cases (24%) and adenectomy in 7 cases (11%). Mean stricture length was 0.6 cm (0.4 – 2 cm range). Stricture length was smaller than 1 cm in 30 cases and larger than 1 cm and up to 2 cm in 33 cases. A single incision at the 12 o´clock position was carried out in 37 patients (58%) (Group1) and incisions at the 12, 9 and 3 o’clock positions were carried out in 26 patients (42%) (Group 2). The corresponding Subgroups were 1A (n=16, 25%), 1B (n=20, 31%), 2A (N=13, 20%) and 2B (n=14, 22%). After initial IU, 41 patients presented with recurrence with a mean recurrence-free period of 32 months (2-97 month range). Significant difference with Cox proportional hazards model was observed among subgroups (P = 0.0004)
Conclusions: Internal urethrotomy plays an important role in short-length urethral stricture management. Three cold-knife incisions at the 12, 9 and 3 o’clock positions are recommended as a modification of the Sachse technique, providing better results and increasing long-term recurrence-free period. Once recurrence presents, IU offers a low success rate and urethroplasty is the more adequate therapeutic option.

REFERENCES

1. Zonana FE. Uretrotomía interna, experiencia en el hospital central militar. Rev Mex Urol. 1982;42:235-39.

2. Jiménez A. Estenosis de uretra masculina. Rev Mex Urol. 1983;43:1.

3. Velázquez R, et al. Uretrotomía interna en el tratamiento de la estenosis de uretra. Experiencia en el Hospital Regional Licenciado Adolfo López Mateos Rev Mex Urol. 1999;59(5):219.

4. Basurto S. et al. Experiencia en el manejo de la estenosis de uretra posterior. Rev. Mex. Uro. 2001;61(6):278-283.

5. Santucci RA, Joyce GF, Wise M Male. Urethral Stricture Disease. J Urol. 2007;177(5):1667-74.

6. Heyns CF, Marais DC. Prospective Evaluation of The American Urological Association Symptom Index and Peak Urinary Flow Rate For The Follow-up of Men With Know Urethral Stricture Disease. J Urol. 2002;168(5):2051-4

7. Kashefi CKashefi C, Messer K, Barden R, Sexton C, Parsons JK. Inci- Incidence and Prevention of Iatrogenic Urethral Injuries. J Urol. 2008;179(6):2254-7.

8. Heyns CF, Steenkamp JW, De Kock ML, Whitaker P. Treatment of Male Urethral Stricture: Is Repeated Dilation or Internal Urethrotomy Useful? J Urol. 1998;160(2):356-8.

9. Barbagli G, Palminteri E, Lazzeri M, Guazzoni G, Turini D. Long-Term Outcome of Urethroplasty After Failed Urethrotomy Versus Primary Repair. J Urol. 2001;165(6 Pt 1):1918-9.

10. Roca E. et al. Uretroplastia con mucosa oral en estenosis de uretra anterior. Actas Urol Esp. 2008;32(5):517-521.

11. Milroy E. Treatment of Recurrent Urethral Strictures. J Urol. 1996;156(1):78-9.

12. Mandhani A, Chaudhury H, Kapoor R, Srivastava A, Dubey D, Kumar A. Can Outcome of Internal Urethrotomy For Short Segment Bulbar Urethral Stricture Be Predicted?. J Urol. 2005;173(5):1595-7.

13. Rourke KF, Jordan GH. Primary Urethral Reconstruction: The Cost Minimized Approach To The Bulbous Urethral Stricture. J Urol. 2005;173(4):1206-10.

14. Albers P, Fichtner J, Brühl P, Müller SC. Long-Term Results of Internal Urethrotomy. J Urol. 1996;156(5):1611-4.

15. Pansadoro V, Emiliozzi P. Internal urethrotomy in the management of anterior urethral strictures: long-term follow-up. J Urol. 1996;156(1):73-5.

16. Eltahawy EA, Virasoro R, Schlossberg SM, McCammon KA, Jordan GH. Long-Term Followup for Excision and Primary Anastomosis for Anterior Urethral Strictures. J Urol. 2007;177(5):1803-6.