"I was told ~50% success for initial procedure with the other 50% requiring self-therapy with a balloon catheter after a second procedure. Urethroplasty only considered in extreme cases."
1. The popularly-quoted 50% success rate with urethrotomy isn't a blanket figure. That's if you carefully select just the best strictures - short, flimsy, previously untreated, single strictures, located in the bulbar urethra. Repeat urethrotomies have extremely low cure rates (typically zero).
2. There's the old 'reconstructive ladder' again - the idea that you should reserve urethroplasty for 'extreme cases' once doing urethrotomies over and over again becomes impossible.
(a) the 'reconstructive ladder' is long discredited in the medical literature, and
(b) urethromy or urethroplasty is the patient's choice.
Urethroplasty is more invasive than endoscopic urethroplasty, but it has far higher long-term success rates. It is is more demanding surgery, best performed by a specialist, rather than a general urologist.
Article:
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How to Pass the FRCS(Urol)
Q. Describe, in general terms, how you would manage an anterior urethral stricture:
Avoid the so-called "reconstructive ladder" where several urethral dilatations are followed by several optical Urethrotomies and eventually definitive surgery in the form of an Urethroplasty. This sequential process may extend the length and depth of the stricture increasing the complexity and compromising the outcome of Urethroplasty.
Aims of treatment of urethral stricture disease: firstly define the goal of treatment, which essentially is whether the patient wishes his/her stricture to be _managed_ (periodic dilatations or Urethrotomies) or _cured_ (by Urethroplasty).
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Self-catheterization is a traumatic maneuver that most patients view with considerable disdain as a painful, time-consuming, embarrassing, difficult and unnatural practice they would gladly abandon if given the choice. False passages will develop in most cases over time, further complicating the problem. Today we can and must do better.
Urethral Stricture is Now an Open Surgical Disease
Allen Morey
Department of Urology
University of Texas Southwestern Medical Center
Dallas, Texas
0022-5347/09/1813-0953/0 Vol. 181, 953-955, March 2009
THE JOURNAL OF UROLOGY®
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Repeat Urethrotomy and Dilation for Urethral Stricture Disease is neither Clinically Effective Nor Cost-Effective
http://www.urotoday.com/urologic-trauma-and-reconstruction-1345/repeat-urethrotomy-and-dilation-for-urethral-stricture-disease-is-neither-clinically-effective-nor-costeffective-1277.html
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Urethral Stricture Tips
The literature is relatively uniform in stating that the patient who may enjoy success from an internal urethrotomy or dilation with curative intent will have a short segment stricture (1 to 1 1â2 cm.), will have relatively superficial spongiofibrosis, and the stricture will be located in the bulbous urethra.
The success rate for internal urethrotomy and dilation for strictures other than in the bulbous urethra is dismally poor.
There is also ample literature which states that repetitive dilation and internal urethrotomy never proceed to cure, but they certainly proceed to spreading the stricture disease, making reconstruction more difficult, and making the results of subsequent reconstruction less than they would have been should the stricture have been addressed initially.
http://www.medicalnewstoday.com/articles/117793.php
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EDITORIAL COMMENT
... this article also casts doubt on the practice of self-catheterization to try to keep strictures open after urethrotomy.