The Role of Topical Steroid Application During Intermittent Self Urethral Dilatation in Reducing the Recurrence Rate of Anterior Urethral Stricture Following Direct Visualized Internal Urethrotomy - A Cohort Study

Abstract

Background: Direct visual internal urethrotomy (DVIU) is recommended initial treatment of single or multiple anterior urethral strictures shorter than 2 cm that are of different underlying etiologies. The major drawback of DVIU is the high recurrence rates of stricture. Objective: The aim of this study was to evaluate the role of use of local steroid (triamcinolone ointment) during intermittent self urethral catheter dilatation in the reducing or prevention of urethral stricture recurrence after DVIU. Methods: A prospective comparative study included 30 male patients in total who were recently diagnosed with anterior urethral stricture involving the penile and/or the bulbar urethra and undergoing DVIU.  Post-operatively, the patients were sub grouped into two main groups (group A and group B) each of them containing 15 cases. The first group instructed to do a clean intermittent self catheter dilatation (ISCD) using triamcinolone ointment as a lubricant whereas the second group used lidocaine gel for lubrication of the catheter over the next six months after DVIU. Those patients were followed-up for at least twelve months in minimum with urethroscopy and/or retrograde urethrogram. Re-evaluation was done at six and twelve months of follow-up period. Results: During follow-up studies, the urethral stricture rate of recurrence were studied between the two patients groups. Regarding the age of patients and stricture site, length and underlying etiology, there were no statistically significant differences between the two studied groups. In contrast, the stricture recurrence rate was statistically significantly lower in the first group (group A) in whom triamcinolone ointment was used as a lubricant than group B in whom only the water-soluble lubricant gel was used. There was also a statistically significant correlation between the stricture recurrence and the stricture length in millimeters (P=0.02). Conclusions: The usage of triamcinolone in the form of ointment on the surface of catheter and installation into urethral lumen during self intermittent urethral dilatation by patients for six months after DVIU has reduced the stricture recurrence rate in significant proportion of cases.