Internal optical urethrotomy: effectiveness and its place in modern urology

Kotov S.V., Belomytcev S.V., Surenkov D.N., Pul'bere S.A., Guspanov R.I., Yusufov A.G., Abdulhalygov E.H., Semenov M.K.

Introduction. Urethral stricture treatment still remains a complex issue in the field of reconstructive urology. The tendency for minimally invasive treatment leads to the application of internal optical urethrotomy (IOU), whose effectiveness is open to question.

Aim. To evaluate the real effectiveness of IOU and to identify prognostic factors of stricture recurrence.

Materials and methods. 124 IOUs were performed in N.I.Pirogov Clinical Hospital №1. After excluding all patients with the stricture of the urethrovesical anastomosis after X-ray therapy and those, who did not want to have the examination suggested, we have 51 persons, who have finished it. Median duration of monitoring was 30.4 months (9-60 months), mean age of the patients was 69.4 years. Mean stricture length was 0.62 cm (0.3-2 cm).

Results. The patients were divided into three groups. The “Absolute Effectiveness of IOU” group consisted of 22 patients (43%), who did not have any signs of stricture recurrence or complaints, and did not have any interventions after IOU. The “Relative ineffectiveness of IOU” group consisted of 20 patients (39%), who did not have any interventions in the urethra after having IOU. However, they demonstrated dynamic worsening of the results of medical examination or had complaints regarding urination difficulties. The “absolute ineffectiveness of IOU” group was represented by 9 patients (18%) diagnosed with stricture recurrence, which required instrumental or surgical correction.

Depending on etiology, we obtained the following values for the effectiveness of IOT. 40% — for idiopathic strictures, 52% — for strictures after transurethral surgery, 63% — after urethroplasty. The effectiveness of IOU after adenomectomy and bougination was only 20%; IOT was ineffective for treating patients with traumatic strictures.

In this study, there were only 25% of positive results of repeated urethrotomies.

Conclusion. According to critical assessment of the results of IOU, the effectiveness of the method was 43%. Herewith, the best results (52% and 63%) were achieved after treatment of urethral strictures, which were developed after transurethral interventions or recurrent complications after urethroplasty, correspondingly.

Authors declare lack of the possible conflicts of interests

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urethral stricture, urethroplasty, spongiofibrosis, uretherotomy, internal optical urethrotomy, efficacy of uretherotomy