HF01-10 EVOLUTION TO EXTINCTION?: THE SAGA OF FEMALE URETHRAL DILATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023HF01-10 EVOLUTION TO EXTINCTION?: THE SAGA OF FEMALE URETHRAL DILATION Jasmine Kashkoush and Brant Fulmer Jasmine KashkoushJasmine Kashkoush More articles by this author and Brant FulmerBrant Fulmer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, many women have reported bothersome urinary symptoms and recurrent urinary tract infections (UTIs). The challenge in managing these symptoms led to the practice of urethral dilation in the 1920s, despite the rarity of a female urethral stricture. With little scientific data to support its efficacy, this practice should have gone to extinction; however, it is still very common. This represents a historical review of urethral dilation in women and its penetration in modern day practice patterns. METHODS: A literature review was performed to evaluate the history of female urethral dilation. RESULTS: In 1923, Stevens theorized the culprit behind bothersome urinary symptoms was a narrow urethral meatus, initially presenting the idea of urethral dilation/incision. He advocated for urethral meatotomy with a scalpel up to 30 Fr. This was refined by Davis in the 1950s with the use of an Otis urethrotome to incise the urethra up to 45 Fr. This was popularized in the 1960s when Keitzer, Lyon, and Kerr thought persistent UTIs were due to a “contraction ring in the distal urethra of little girls.” They used sounds and Otis urethrotomes in infants to dilate and/or incise the entire urethra. Eventually, this practice lost scientific backing due to complications of urinary incontinence as well as favorable outcomes with less invasive options. In fact, the last reference to using urethral dilation without a urethral stricture was in 1970. Interestingly, despite the lack of data to support its use, Medicare reimbursement still shows high utilization and cost expenditures. Almost $70 million was spent in 2000 despite only ∼40 documented cases of female urethral stricture. Furthermore, when surveying urologists, those who completed residency after 1989 rarely performed urethral dilation when compared to their predecessors who find it a useful practice. CONCLUSIONS: A wide variety of treatment modalities have been used to manage recurrent UTIs and irritative lower urinary tract symptoms. Female urethral dilation was common despite the rarity of a female urethral stricture. Urinary incontinence and a better understanding of bladder function have decreased the data in favor of female urethral dilation, putting into question its practice. Evidence based medicine supports medical management, vaginal estrogen, and pelvic floor physical therapy more favorably. One would hope that this practice would go into extinction; however, Medicare data still shows high utilization. Perhaps updated guideline statements and better education of patients that have had prior dilations will help in debunking this practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e259 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jasmine Kashkoush More articles by this author Brant Fulmer More articles by this author Expand All Advertisement PDF downloadLoading ...