Post-operative care following primary optical urethrotomy: towards an evidence based approach

Abstract

Introduction: Optical urethrotomy (OU) is the commonest procedure performed for primary bulbar urethral strictures. Recurrence rates of up to 50% are reported, but data is lacking on the influence of post-operative management regimes on patient’s outcomes. The aim of this study was to quantify the variation in treatment approaches within a region and determine from the literature what constitutes best practice. Methods: A survey regarding post-operative management following OU was sent to urologists in the Yorkshire Deanery. The questions related to post-operative catheter usage, intermittent self dilatation (ISD) regimes and follow-up investigations. A literature review regarding these aspects of post-operative care was subsequently performed. Results: Questionnaires were sent to 70 urologists, of which 42 urologists replied. All respondents insert a urethral catheter following OU. Two thirds of respondents advise patients to perform ISD but one third of those advise continuing for only 6 months. Uroflowmetry and post micturition residual estimation are the mainstay of follow up investigations. Conclusions: The practice in our region largely reflects the best available evidence. The literature suggests that catheter size/material has no effect on outcome. Catheter duration should be for less than 3 days due to increased risk of recurrence. ISD should be performed for at least one year as this is associated with significantly lower recurrence rates than 6 months treatment. Urethrography is more accurate than uroflowmetery for follow up but results must be correlated with patient symptoms.